Provider Demographics
NPI:1881153963
Name:MEDINA, RUBELETA (NP-C)
Entity type:Individual
Prefix:
First Name:RUBELETA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:RUBELETA
Other - Middle Name:VELANDO
Other - Last Name:SARMIENTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:12024 CALLE DE LEON
Mailing Address - Street 2:UNIT 78
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4950
Mailing Address - Country:US
Mailing Address - Phone:619-713-6421
Mailing Address - Fax:619-749-5898
Practice Address - Street 1:9995 CARMEL MOUNTAIN RD STE B10-11
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2889
Practice Address - Country:US
Practice Address - Phone:844-200-2426
Practice Address - Fax:858-240-6470
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2024-04-11
Deactivation Date:2019-04-10
Deactivation Code:
Reactivation Date:2022-08-11
Provider Licenses
StateLicense IDTaxonomies
CA751801163WG0000X
CA95011111363LF0000X
CANP95011111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice