Provider Demographics
NPI:1508658352
Name:MEDINA, SELENE GUADALUPE (PPS)
Entity type:Individual
Prefix:MRS
First Name:SELENE
Middle Name:GUADALUPE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:SELENE
Other - Middle Name:GUADALUPE
Other - Last Name:DE HARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPS
Mailing Address - Street 1:571 E CITRUS DR
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93223-1274
Mailing Address - Country:US
Mailing Address - Phone:559-592-2010
Mailing Address - Fax:
Practice Address - Street 1:571 E CITRUS DR
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:CA
Practice Address - Zip Code:93223-1274
Practice Address - Country:US
Practice Address - Phone:559-592-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool