Provider Demographics
NPI:1447508676
Name:MEDINA, PATRICIA E (BS, IBCLC, CCE)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:MEDINA
Suffix:
Gender:F
Credentials:BS, IBCLC, CCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9211 WASHBURN RD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2908
Mailing Address - Country:US
Mailing Address - Phone:562-254-4669
Mailing Address - Fax:
Practice Address - Street 1:9211 WASHBURN RD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2908
Practice Address - Country:US
Practice Address - Phone:562-254-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11178012174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN