Active NPI
Benjamin Medina
- Addiction (Substance Use Disorder) Counselor
- Van Nuys, CA
National Provider Identifier
1780978692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 071425-II
- Practice address
- 5935 Van Nuys Blvd
Van Nuys, CA 91401-3624 - Phone
- (818) 285-1900
- Fax
- (181) 285-1906
- NPI assigned
- Jun 8, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 071425-II | CA | Primary |
Addresses
Primary practice location
5935 Van Nuys Blvd
Van Nuys, CA 91401-3624
Mailing address
PO Box 921015
Sylmar, CA 91392-1015
Phone (818) 285-1900
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 |
|---|---|---|---|
| 071425-II | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Fernando Valley Community Mental Health Center, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Van Nuys, CA
- NPI 1487830725
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307491200000",
"number": "1780978692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 921015",
"city": "SYLMAR",
"state": "CA",
"postal_code": "913921015",
"telephone_number": "818-285-1900",
"fax_number": "818-285-1906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5935 VAN NUYS BLVD",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914013624",
"telephone_number": "818-285-1900",
"fax_number": "181-285-1906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "BENJAMIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-08",
"last_updated": "2011-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "071425-II",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Van Nuys, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.