Medina Dautovic

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

113769 Issued in CA

Practice address

2600 S El Camino Real
San Mateo, CA 94403-2380

Phone

(650) 578-8691

NPI assigned

Jan 25, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Caminar

  dba Olivos

  • Community/Behavioral Health Agency
  • Redwood City, CA
  • NPI 1992252829
  NPD (past)

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

{
    "created_epoch": "1516838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677196800000",
    "number": "1972001899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 S EL CAMINO REAL",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944032380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 S EL CAMINO REAL",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944032380",
            "telephone_number": "650-578-8691"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 E Virginia St Ste 100",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951125865",
            "country_code": "US",
            "telephone_number": "408-579-6178",
            "fax_number": "408-579-6143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAUTOVIC",
        "first_name": "MEDINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-25",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "ASW89224",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "113769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mahdis Darabi
• Brian Dargiewicz, RN, PMHNP-BC
• Ashlyn Aarti Datt
• Jerry Dattilo, BA
• Kelsey Anne Fruehan Dattilo
• David M Isenman MD Inc
• Sarah Brown David, PSYD
• Aaron Davis, FDN
• Catherine Elizabeth Maxine Davis
• Deatria Davis

• Clinical Social Worker in San Mateo, CA
• Providers in San Mateo, 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 Feb 24, 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.

Verify at the official NPI Registry.