Edgardo Medina-Colon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

114327 Issued in CA

Practice address

60 MDG/Sgof
101 Bodin Cir
Travis Afb, CA 94535-1809

Phone

(707) 423-3057

NPI assigned

May 21, 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

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

{
    "created_epoch": "1558396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1255998696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MDG/SGOF",
            "address_2": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MDG/SGOF",
            "address_2": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA-COLON",
        "first_name": "EDGARDO",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-21",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "114327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John McKeon, MD
• Connor McKinney, DO
• Shawn Regina McMahan
• Joseph Benjamin McNeal V, MD
• Kimbray Nichole McNeal, LCSW
• Janelle Morelos Medina-Vicente
• Christopher Albert Meinhart, M.D.
• Diego Melgar-Gray, PA-C
• Joseph Andrew Mellen IV, MD
• Audra Krystell Mendelsohn, M.D.

• Clinical Social Worker in Travis Afb, CA
• Providers in Travis Afb, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.