Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 207QA0505X | Family Doctor - Adult Medicine | 0000000 | TX |
NPI | 1295360782 |
---|---|
Provider Name | Brandi Medina |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Woodland Hills, CA 91367-7807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2020 |
Last Update Date | 05/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000000000 | (05) | TX |
0000000000 | AETNA (01) | TX |
808409140860054 | AETNA (01) |