Sandra Angelica Medina

Primary specialty

Licensed Psychiatric TechnicianTaxonomy code 167G00000X

License

40294 Issued in CA

Practice address

2900 E del Mar Blvd
Pasadena, CA 91107-4375

Phone

(626) 795-9901

Fax

(626) 356-2503

NPI assigned

Jun 1, 2007

Last updated

Feb 8, 2019By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549584000000",
    "number": "1871795823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N HAMBLEDON AVE",
            "city": "LA PUENTE",
            "state": "CA",
            "postal_code": "917445323",
            "telephone_number": "626-581-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 E DEL MAR BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911074375",
            "telephone_number": "626-795-9901",
            "fax_number": "626-356-2503"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1517 W Garvey Ave N",
            "address_purpose": "LOCATION",
            "city": "West Covina",
            "state": "CA",
            "postal_code": "917902138",
            "country_code": "US",
            "telephone_number": "626-962-6061 x36",
            "fax_number": "626-962-4471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "SANDRA",
        "middle_name": "ANGELICA",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-01",
        "last_updated": "2019-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "40294",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maline Angelica Medina
• Maria A Medina
• Michelle Medina
• Miguel Julian Medina
• Rosa Isabel Medina, RN
• Sara Michlelle Medina
• Yessenia Guadalupe Medina
• Angelina Marie Medinilla
• Meditas Corporation (Health Care Provider)
• Nia Nichelle Ada Medlock

• Licensed Psychiatric Technician in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Licensed Psychiatric Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.