Active NPI
Lisette Medina, AMFT
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1326744525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 137261
- Practice address
- 10801 National Blvd Ste 435
Los Angeles, CA 90064-4139 - Phone
- (424) 465-1953
- NPI assigned
- Jan 31, 2023
- 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 | 137261 | CA | Primary |
Addresses
Primary practice location
10801 National Blvd Ste 435
Los Angeles, CA 90064-4139
Mailing address
PO Box 27111
Los Angeles, CA 90027-0111
Phone (424) 465-1053
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 137261 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675123200000",
"number": "1326744525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 27111",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900270111",
"telephone_number": "424-465-1053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10801 NATIONAL BLVD STE 435",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900644139",
"telephone_number": "424-465-1953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "LISETTE",
"credential": "AMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-31",
"last_updated": "2023-01-31",
"certification_date": "2023-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "137261",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.