Provider Demographics
NPI:1730106584
Name:CONCEPCION-MEDINA, ANA REYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:REYA
Last Name:CONCEPCION-MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1164 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1900
Mailing Address - Country:US
Mailing Address - Phone:714-778-0623
Mailing Address - Fax:714-778-3437
Practice Address - Street 1:947 S ANAHEIM BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5582
Practice Address - Country:US
Practice Address - Phone:714-758-2858
Practice Address - Fax:714-758-3723
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA60343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist