Active NPI
Miguel Angel Medina, PAC
- Physician Assistant
- Pomona, CA
National Provider Identifier
1447232640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10383
- Practice address
- 795 E Second St.
Suite 5
Pomona, CA 91766-2007 - Phone
- (909) 865-2565
- Fax
- (909) 865-2955
- NPI assigned
- Nov 15, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10383 | CA | Primary |
Addresses
Primary practice location
795 E Second St.
Suite 5
Pomona, CA 91766-2007
Mailing address
795 E. Second Street
Suite 5
Pomona, CA 91766-2007
Phone (909) 865-2565
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA10383 | Medicaid | CA |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10383 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340150400000",
"number": "1447232640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "795 E. SECOND STREET",
"address_2": "SUITE 5",
"city": "POMONA",
"state": "CA",
"postal_code": "917662007",
"telephone_number": "909-865-2565",
"fax_number": "909-865-2955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "795 E SECOND ST.",
"address_2": "SUITE 5",
"city": "POMONA",
"state": "CA",
"postal_code": "917662007",
"telephone_number": "909-865-2565",
"fax_number": "909-865-2955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "MIGUEL",
"middle_name": "ANGEL",
"name_prefix": "Mr.",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-15",
"last_updated": "2012-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA10383",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PA10383",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.