Diana Marcela Medina, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

50643 Issued in CA

Practice address

11980 San Vicente Blvd
Suite 505
Los Angeles, CA 90049-5012

Phone

(310) 820-6691

Fax

(310) 820-6041

NPI assigned

Aug 10, 2006

Sex

Female

Sole proprietor

Yes

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003827551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10620 EASTBORNE AVE",
            "address_2": "APT # 302",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900245985",
            "telephone_number": "310-490-6674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11980 SAN VICENTE BLVD",
            "address_2": "SUITE 505",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495012",
            "telephone_number": "310-820-6691",
            "fax_number": "310-820-6041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "DIANA",
        "middle_name": "MARCELA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "50643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claudia Medina
• Cynthia Vanessa Medina, PA-C
• Daniel Medina
• Desiree America Medina
• Devon Lacey Medina, LCSW
• Elisabet Medina
• Elizabeth Medina
• Erika Medina, PSYD
• Evelyn Medina
• Evelyn Medina

• Oral and Maxillofacial Surgery (Dentist) in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.