Provider Demographics
NPI:1922708775
Name:MEDINA VERDUGO, ALIX ANDREA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:ALIX
Middle Name:ANDREA
Last Name:MEDINA VERDUGO
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1959
Mailing Address - Country:US
Mailing Address - Phone:619-373-6787
Mailing Address - Fax:
Practice Address - Street 1:3633 CAMINO DEL RIO S STE 206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4014
Practice Address - Country:US
Practice Address - Phone:619-373-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM700176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife