Individual provider Active NPI

Estefani Medina

  • Behavior Technician
  • Downey, CA
National Provider Identifier
1104395912
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
12432 Bellflower Blvd
Downey, CA 90242-2806
Phone
(818) 241-6780
Fax
(818) 241-6853
NPI assigned
Nov 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Primary
Marriage & Family Therapist 106H00000X 123566 CA

Addresses

Primary practice location

12432 Bellflower Blvd
Downey, CA 90242-2806

Mailing address

9680 Sycamore Canyon Rd
Moreno Valley, CA 92557-1813
Phone (909) 685-8521

Other practice location 1

3637 Arlington Ave
Riverside, CA 92506-3923
Phone (951) 788-7460 ext. 40874

Other names 1

  • Estefani Medina Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260603002411 CA Practitioner - Marriage and Family Therapist 2769953447 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

402 W Broadway
Suite 400
San Diego, CA 92101-3554

9680 Sycamore Canyon Rd
Moreno Valley, CA 92557-1813

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1542758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1104395912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9680 SYCAMORE CANYON RD",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925571813",
            "telephone_number": "909-685-8521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12432 BELLFLOWER BLVD",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902422806",
            "telephone_number": "818-241-6780",
            "fax_number": "818-241-6853"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3637 Arlington Ave",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925063923",
            "country_code": "US",
            "telephone_number": "951-788-7460 x40874",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "ESTEFANI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-21",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "123566",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ESTEFANI",
            "last_name": "MEDINA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Downey, CA

Sources for this page

Verify at the official NPI Registry.