Cristobal Armando Medina, RADT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

13889-R Issued in CA

Practice address

656 N Park Ave
Pomona, CA 91768-3679

Phone

(909) 629-4084

NPI assigned

Apr 16, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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.

• Social Model Recovery Systems, Inc.

  • Community/Behavioral Health Agency
  • Pomona, CA
  • NPI 1447615539

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1586995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586995200000",
    "number": "1386264661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "656 N PARK AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683679",
            "telephone_number": "909-629-4084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "656 N PARK AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683679",
            "telephone_number": "909-629-4084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "CRISTOBAL",
        "middle_name": "ARMANDO",
        "name_prefix": "Mr.",
        "credential": "RADT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-16",
        "last_updated": "2020-04-16",
        "certification_date": "2020-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "13889-R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medi-Cure Health Services, Inc
• Medi-Cure Health Services, Inc.
• Medical Health Clinic Salud & Familia, a Professional Corportation
• Rocio Iliana Medina-Ovando
• Celeste Medina
• Francine Medina
• Ivan Medina
• Miguel Angel Medina, PAC
• Rienne Perlisa Medina
• Sonia Rene Medina

• Addiction (Substance Use Disorder) Counselor in Pomona, CA
• Providers in Pomona, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2020; 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.