Provider Demographics
NPI:1629157110
Name:MEDINA, HILDA YAMEL (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:HILDA
Middle Name:YAMEL
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FREMONT VA
Mailing Address - Street 2:39199 LIBERTY STREET BLDG B
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-791-4001
Mailing Address - Fax:510-791-4036
Practice Address - Street 1:FREMONT VA
Practice Address - Street 2:39199 LIBERTY STREET BLDG B
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-791-4001
Practice Address - Fax:510-791-4036
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060314791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496866104Medicaid