Active NPI
Johnna Leigh Medina, PHD
- Clinical Psychologist
- Palo Alto, CA
National Provider Identifier
1306492236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 31454
- Practice address
- 401 Quarry Rd # Mc5718
Palo Alto, CA 94304-1419 - Phone
- (650) 497-4489
- NPI assigned
- Aug 15, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 31454 | CA | Primary |
Addresses
Primary practice location
401 Quarry Rd # Mc5718
Palo Alto, CA 94304-1419
Mailing address
2491 24TH Ave
San Francisco, CA 94116-2336
Phone (818) 632-3941
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2021 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31454 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578009600000",
"number": "1306492236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2491 24TH AVE",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941162336",
"telephone_number": "818-632-3941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 QUARRY RD # MC5718",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943041419",
"telephone_number": "650-497-4489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "JOHNNA",
"middle_name": "LEIGH",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-15",
"last_updated": "2020-01-03",
"certification_date": "2020-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "31454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.