Ingrid Veronica Medina

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW109606 Issued in CA

Practice address

1525 Silver Ave # 2
San Francisco, CA 94134-1229

Phone

(415) 657-1700

NPI assigned

Aug 17, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

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.

• Center for New Directions, Inc.

  • Mental Health Counselor
  • Laguna Hills, CA
  • NPI 1578121190
  NPD (past)

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

{
    "created_epoch": "1502928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1265958565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "338 ALEMANY BLVD APT 3",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941106156",
            "telephone_number": "925-621-9702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 SILVER AVE # 2",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941341229",
            "telephone_number": "415-657-1700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "916 McHenry Ave",
            "address_purpose": "LOCATION",
            "city": "Modesto",
            "state": "CA",
            "postal_code": "953505417",
            "country_code": "US",
            "telephone_number": "209-550-5850",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 Estudillo Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "San Leandro",
            "state": "CA",
            "postal_code": "945774962",
            "country_code": "US",
            "telephone_number": "510-352-9200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "INGRID",
        "middle_name": "VERONICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-17",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "84690",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "109606",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW109606",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90903175D26028",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marylou Santos Medina-Bolus, LVN
• Annelis Medina
• Candice Castro Medina, FNP-C
• Darla Rae Medina
• Gina Martinez Medina, N.P
• Julia Medina
• Julian David Medina, MD
• Kristal A Medina
• Lauren Alexis Marcelino Medina, RN
• Lidia Marisol Medina

• Clinical Social Worker in San Francisco, CA
• Providers in San Francisco, 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 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.