Provider Demographics
NPI:1447665344
Name:MEDINA, ANNA MARIA
Entity type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:MARIA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 S BREEZY WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-5003
Mailing Address - Country:US
Mailing Address - Phone:213-304-8751
Mailing Address - Fax:
Practice Address - Street 1:401 S TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2550
Practice Address - Country:US
Practice Address - Phone:714-244-4322
Practice Address - Fax:714-244-4330
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator