Provider Demographics
NPI:1265905848
Name:MEDINA, JONI
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 TELEPHONE RD APT 93
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2749
Mailing Address - Country:US
Mailing Address - Phone:805-795-9639
Mailing Address - Fax:
Practice Address - Street 1:414 E ALISO ST APT A
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2889
Practice Address - Country:US
Practice Address - Phone:805-795-9639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health