Celerina De Borja Medina

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A45547 Issued in CA

Practice address

4149 Tweedy Boulevard
Ste B
South Gate, CA 90280-6167

Phone

(323) 564-4545

Fax

(323) 564-3063

NPI assigned

May 5, 2006

Last updated

Jun 29, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Celerina B Medina MD Inc

  dba Clinica Medina Medical Office

  • Family Medicine Physician
  • South Gate, CA
  • NPI 1972749216
  Authorized official Same address or phone

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340928000000",
    "number": "1356399919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4149 TWEEDY BOULEVARD",
            "address_2": "STE B",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806167",
            "telephone_number": "323-564-4545",
            "fax_number": "323-564-3063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4149 TWEEDY BOULEVARD",
            "address_2": "STE B",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806167",
            "telephone_number": "323-564-4545",
            "fax_number": "323-564-3063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "CELERINA",
        "middle_name": "DE BORJA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-05",
        "last_updated": "2012-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A45547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A455470",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Inmari A Mazariegos I
• Farzad Mazloomi, DMD
• MC Clinica Familiar, Inc
• Suzette Salas McBrayer, FNP
• Briana Medero Osorio
• Eduardo Medina, RDA
• Christopher Alexander Mejia Serrano
• Nuria Michelle Melgar
• Jack Paul Melmed, OPTOMETRIST
• Sophone R Men

• General Practice Physician in South Gate, CA
• Providers in South Gate, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; 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.