Myrna Jose Medina, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

31482 Issued in CA

Practice address

15 Penny LN Ste 1
Watsonville, CA 95076-6010

Phone

(831) 722-4635

Fax

(831) 722-5735

NPI assigned

Oct 26, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558446575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PENNY LN STE 1",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950766010",
            "telephone_number": "831-722-4635",
            "fax_number": "831-722-5735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PENNY LN STE 1",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950766010",
            "telephone_number": "831-722-4635",
            "fax_number": "831-722-5735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "MYRNA",
        "middle_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "31482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Kathleen McEntee, D.O.
• Michael L McGannon, MD
• Rebecca Anne McGill
• Susana I McNeely, RN
• Krista Medina
• Daniel Mednoza Pacheco
• Renee Meisner-Bogdahn
• Annette Melendrez
• Alvaro Melgoza
• Melissa Lopez-Bermejo, MD

• Dentist in Watsonville, CA
• Providers in Watsonville, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.