Loi C Medvin, M.A., PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY23692 Issued in CA

Practice address

825 College Ave Ste 4
Santa Rosa, CA 95404-4108

Phone

(707) 962-4196

NPI assigned

Jul 17, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1245439348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "924 MCFARLANE AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724420",
            "telephone_number": "707-695-7888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 COLLEGE AVE STE 4",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044108",
            "telephone_number": "707-962-4196"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "149 Stony Cir",
            "address_2": "Ste 210",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954014158",
            "country_code": "US",
            "telephone_number": "707-570-0803",
            "fax_number": "707-570-0809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDVIN",
        "first_name": "LOI",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.A., PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-17",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY23692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "122742",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Medina & Oliva Dental PC (Cascade Family Dental)
• Cesar Ulyces Medina, PT
• Edgar Medina
• Ivan Medina
• Kayla Elyse Medina, NP
• Michael L. Medvin, M.D.
• Avery Meek
• Stephen Meffert, M.D.
• Mehdipour DMD PC
• Navid Mehdipour

• Clinical Psychologist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.