Provider Demographics
NPI:1043024847
Name:MEDINA, ALEJANDRA PATRICIA (CNA)
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:PATRICIA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4542 FELTON ST APT H
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4474
Mailing Address - Country:US
Mailing Address - Phone:619-895-8662
Mailing Address - Fax:
Practice Address - Street 1:3570 CAMINO DEL RIO N STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1747
Practice Address - Country:US
Practice Address - Phone:619-507-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01176049376K00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376K00000XNursing Service Related ProvidersNurse's Aide