Active NPI
Louisiana Medina
- Mental Health Counselor
- Los Angeles, CA
National Provider Identifier
1861774978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 510 S Vermont Ave
Los Angeles, CA 90020-1912 - Phone
- (213) 760-3568
- NPI assigned
- Sep 14, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary | ||
| Social Worker | 104100000X | 76169 | CA |
Addresses
Primary practice location
510 S Vermont Ave
Los Angeles, CA 90020-1912
Mailing address
3751 Stocker St
Los Angeles, CA 90008-5101
Phone (323) 298-3680
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 |
|---|---|---|---|
| 76169 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690329600000",
"number": "1861774978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3751 STOCKER ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900085101",
"telephone_number": "323-298-3680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 S VERMONT AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900201912",
"telephone_number": "213-760-3568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "LOUISIANA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-14",
"last_updated": "2023-07-26",
"certification_date": "2023-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "76169",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.