Provider Demographics
NPI:1740074434
Name:MEDINA GONZALEZ, ISAAC (FNP)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:MEDINA GONZALEZ
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 MAIN ST STE 301E
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2683
Mailing Address - Country:US
Mailing Address - Phone:626-443-4300
Mailing Address - Fax:626-443-9646
Practice Address - Street 1:11001 MAIN ST STE 301E
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2683
Practice Address - Country:US
Practice Address - Phone:626-443-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily