Active NPI
Eduardo Medina, RDA
- Dental Assistant
- South Gate, CA
National Provider Identifier
1629652854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 92794
- Practice address
- 8454 Victoria Ave Apt C
South Gate, CA 90280-2364 - Phone
- (818) 445-1201
- NPI assigned
- May 12, 2021
- 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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 92794 | CA | Primary |
Addresses
Primary practice location
8454 Victoria Ave Apt C
South Gate, CA 90280-2364
Mailing address
8454 Victoria Ave Apt C
South Gate, CA 90280-2364
Phone (818) 445-1201
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 92794 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 92794 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620777600000",
"number": "1629652854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8454 VICTORIA AVE APT C",
"city": "SOUTH GATE",
"state": "CA",
"postal_code": "902802364",
"telephone_number": "818-445-1201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8454 VICTORIA AVE APT C",
"city": "SOUTH GATE",
"state": "CA",
"postal_code": "902802364",
"telephone_number": "818-445-1201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "EDUARDO",
"name_prefix": "Mr.",
"credential": "RDA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-12",
"last_updated": "2021-05-12",
"certification_date": "2021-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "92794",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "92794",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Gate, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.