Mediverse Medical Network

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MEDIVERSE MEDICAL NETWORK

Practice address

1910 S Union St Unit 1082
Anaheim, CA 92805-7430

Phone

(818) 626-4883

NPI assigned

Jun 28, 2022

Organization subpart

No

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

Authorized official

Name

Cristina Enriquez

Title

President

Phone

(818) 626-4883

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1487386488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 S UNION ST UNIT 1082",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928057430",
            "telephone_number": "818-626-4883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 S UNION ST UNIT 1082",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928057430",
            "telephone_number": "818-626-4883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIVERSE MEDICAL NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "ENRIQUEZ",
        "authorized_official_first_name": "CRISTINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-626-4883"
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theissy Sarahed Medina
• Tiffany Medina
• Veronica Medina, NP
• Yuna Han Medina, MD
• Medirush LLC
• Medphaco Inc (Health First Pharmacy)
• Medplus DME
• Medplus Transport Inc
• Jessica Estefania Medrano-Renteria
• Angel Medrano

• General Practice Physician in Anaheim, CA
• Providers in Anaheim, 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 28, 2022; 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.