Andrea Crystal Medina

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

99958 Issued in CA

Practice address

41 E Foothill Blvd Ste 102
Arcadia, CA 91006-2361

Phone

(626) 701-4249

NPI assigned

Nov 19, 2018

Last updated

Jun 4, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Soultenders, Inc.

  • Clinical Psychologist
  • Arcadia, CA
  • NPI 1164617007
  Medicare reassignment NPD

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

{
    "created_epoch": "1542585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622764800000",
    "number": "1720557853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 E FOOTHILL BLVD STE 102",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910062361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 E FOOTHILL BLVD STE 102",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910062361",
            "telephone_number": "626-701-4249"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25115 Avenue Stanford Ste 100",
            "address_purpose": "LOCATION",
            "city": "Valencia",
            "state": "CA",
            "postal_code": "913554791",
            "country_code": "US",
            "telephone_number": "818-241-6780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "ANDREA",
        "middle_name": "CRYSTAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-19",
        "last_updated": "2021-06-04",
        "certification_date": "2021-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "99958",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "84732",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BBS",
            "identifier": "84732",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.soultenders.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "address_1": "41 E Foothill Blvd Ste 102",
            "city": "Arcadia",
            "state": "CA",
            "country_code": "US",
            "postal_code": "910062361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Medchoice la Home Health Care Inc
• Medford Orthopaedic Medical Corp
• Medford Orthopaedic Medical Corporation
• Medhat N. Nahed, DDS, Ms, Inc
• Medical Imaging Partners (Arcadia MRI Center)
• Gloria Medina
• John Medina, P.A.
• Maria Medina
• Sarah Darlene Medina
• Silvia Medrano Vazquez

• Clinical Social Worker in Arcadia, CA
• Providers in Arcadia, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.