Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | MFC35047 | CA |
N | 101YS0200X | School Counselor | MFC35047 | CA |
NPI | 1033123849 |
---|---|
Provider Name | Mr. Adolfo Jorge Medina |
First Address | Livermore, CA 94550-4798 |
Second Address | Livermore, CA 94550-4798 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 20/08/2011 |