Individual provider Active NPI

Adaligza Medina, LCSW

  • Clinical Social Worker
  • Tustin, CA
National Provider Identifier
1144810953
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
94384 Issued in CA
Practice address
1095 Irvine Blvd
Tustin, CA 92780-3526
Phone
(714) 505-7110
NPI assigned
Jan 25, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 94384 CA Primary

Addresses

Primary practice location

1095 Irvine Blvd
Tustin, CA 92780-3526

Mailing address

1095 Irvine Blvd
Tustin, CA 92780-3526
Phone (714) 505-7110

Other practice location 1

801 E Chapman Ave Ste 203
Fullerton, CA 92831-3846
Phone (714) 680-9000 ext. 9034

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
I20241204001204 CA Practitioner - Clinical Social Worker 6406382258 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
94384CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Nov 25, 2024 Accepting new patients
Providence Medical Foundation CurrentSince Nov 25, 2024 Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

845 W La Veta Ave
Ste 108
Orange, CA 92868
Phone (714) 289-3904

1095 Irvine Blvd
Tustin, CA 92780
Phone (714) 505-7110

Organizations & group practices 3

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": "1611532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1144810953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1095 IRVINE BLVD",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803526",
            "telephone_number": "714-505-7110",
            "fax_number": "714-505-7108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 IRVINE BLVD",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803526",
            "telephone_number": "714-505-7110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 E Chapman Ave Ste 203",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "928313846",
            "country_code": "US",
            "telephone_number": "714-680-9000 x9034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "ADALIGZA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-25",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "94384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.