Nicole G. Medina

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

135401 Issued in CA

Practice address

250 El Camino Real Ste 213
Tustin, CA 92780-3656

Phone

(714) 805-6510

NPI assigned

Jan 26, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Marriage and Family Therapist

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Judy Benvenuto Marriage and Family Therapy Inc

  • Marriage & Family Therapist
  • Tustin, CA
  • NPI 1992319461
  Medicare reassignment

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

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1801548250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1751 COLORADO BLVD # 180",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900411348",
            "telephone_number": "213-379-5371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 EL CAMINO REAL STE 213",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803656",
            "telephone_number": "714-805-6510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "NICOLE",
        "middle_name": "G.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-26",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "135401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yvonne M Medeiros, REGISTERED NURSE
• Medical Diagnostic Allergy Testing, Inc.
• Medical Exam Assoicates
• Adaligza Medina, LCSW
• Joshua Medina
• Meditech Solutions
• Medivan
• Medland Medical Inc.
• Abigail Medrano Duarte
• Megan Plakos Szabo LMFT, a Marriage and Family Therapy Corporation

• Marriage & Family Therapist in Tustin, CA
• Providers in Tustin, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.