Provider Demographics
NPI:1740734946
Name:MEDINA, ROSA ISABEL (RN)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:ISABEL
Last Name:MEDINA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 E DEL MAR BLVD UNIT 22
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4812
Mailing Address - Country:US
Mailing Address - Phone:626-243-3511
Mailing Address - Fax:
Practice Address - Street 1:2450 E DEL MAR BLVD UNIT 22
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4812
Practice Address - Country:US
Practice Address - Phone:626-243-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444748163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse