Provider Demographics
NPI:1740702505
Name:MEDINA, MARIA E (SLPA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:MEDINA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W CAMELLIA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-3365
Mailing Address - Country:US
Mailing Address - Phone:951-537-9945
Mailing Address - Fax:
Practice Address - Street 1:29377 RANCHO CALIFORNIA RD STE 102
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5206
Practice Address - Country:US
Practice Address - Phone:951-595-4673
Practice Address - Fax:951-595-4673
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43752355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty