Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | BOC297927 | CA |
Y | 213ES0000X | Sports Medicine | BOC297927 | CA |
NPI | 1023679826 |
---|---|
Provider Name | Adrianna Medina |
First Address | Covina, CA 91723-3016 |
Second Address | Covina, CA 91723-3016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2019 |
Last Update Date | 24/06/2019 |