Diandra Crystal Medina, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

96724 Issued in CA

Practice address

1450 University Ave # 101
San Diego, CA 92103-3405

Phone

(619) 365-9958

NPI assigned

Sep 2, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• San Diego Youth Services

  • Community/Behavioral Health Agency
  • El Cajon, CA
  • NPI 1194972174
  NPD (past)

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

{
    "created_epoch": "1314921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538524800000",
    "number": "1265713309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4303 AVALON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921031307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 UNIVERSITY AVE # 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033405",
            "telephone_number": "619-365-9958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1870 Cordell Ct Ste 101",
            "address_purpose": "LOCATION",
            "city": "El Cajon",
            "state": "CA",
            "postal_code": "920200915",
            "country_code": "US",
            "telephone_number": "619-448-9700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "DIANDRA",
        "middle_name": "CRYSTAL",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-02",
        "last_updated": "2018-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": "78053",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "96724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittney Margoth Medina
• Carmen Nicole Medina
• Cherry Pink Ramos Medina, RN
• Christina Medina
• Derick Medina, IDC
• Dianitza Medina, LCSW
• Editha Medina
• Elijah Medina
• Elizbeth Medina
• Gabriel Rolando Medina

• Marriage & Family Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.