Active NPI
Imelda Medina, LVN
- Licensed Vocational Nurse
- South San Francisco, CA
National Provider Identifier
1972927424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 259253
- Practice address
- 226 Alta Mesa Dr
South San Francisco, CA 94080-3002 - Phone
- (415) 794-9567
- Fax
- (650) 873-8713
- NPI assigned
- Feb 4, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 259253 | CA | Primary |
Addresses
Primary practice location
226 Alta Mesa Dr
South San Francisco, CA 94080-3002
Mailing address
226 Alta Mesa Dr
South San Francisco, CA 94080-3002
Phone (415) 794-9567
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 |
|---|---|---|---|
| 259253 | CA | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391472000000",
"number": "1972927424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "226 ALTA MESA DR",
"city": "SOUTH SAN FRANCISCO",
"state": "CA",
"postal_code": "940803002",
"telephone_number": "415-794-9567",
"fax_number": "650-873-8713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "226 ALTA MESA DR",
"city": "SOUTH SAN FRANCISCO",
"state": "CA",
"postal_code": "940803002",
"telephone_number": "415-794-9567",
"fax_number": "650-873-8713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "IMELDA",
"credential": "LVN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-04",
"last_updated": "2014-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "259253",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.