Manuel J Medina

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

18-56801 Issued in OK

Practice address

2700 S Shartel Ave
Oklahoma City, OK 73109-2234

Phone

(405) 752-2264

NPI assigned

Dec 17, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Good Shepherd Catholic School at Mercy

  • Behavior Analyst
  • Oklahoma City, OK
  • NPI 1033463773
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1003454307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13404 N MERIDIAN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731208311",
            "telephone_number": "405-752-2264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 S SHARTEL AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731092234",
            "telephone_number": "405-752-2264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "MANUEL",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-17",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "OK",
            "license": "18-56801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andria P Medina, MD
• Frida Axel Medina
• Jesus E Medina, MD
• Jose Medina, PA
• Madeline Emma Medina
• Patrick Medina, PHARM.D.
• Medinas Therapeutic Massage LLC
• Radhika Medipalli, M.D.
• Meditelecare of Oklahoma, LLC
• Brandi Danielle Medley, M.ED.

• Behavior Technician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Behavior Technician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.