Provider Demographics
NPI:1023679826
Name:MEDINA, ADRIANNA (ATC)
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 E ORLANDO WAY
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3016
Mailing Address - Country:US
Mailing Address - Phone:626-545-1722
Mailing Address - Fax:
Practice Address - Street 1:279 E ORLANDO WAY
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3016
Practice Address - Country:US
Practice Address - Phone:626-545-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABOC2979272081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine