Provider Demographics
NPI:1902482748
Name:MEDINA-CAMELLO, LIZETH (FNP-BC)
Entity type:Individual
Prefix:
First Name:LIZETH
Middle Name:
Last Name:MEDINA-CAMELLO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LIZETH
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:6041 CADILLAC AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034
Mailing Address - Country:US
Mailing Address - Phone:323-857-3088
Mailing Address - Fax:
Practice Address - Street 1:6041 CADILLAC AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034
Practice Address - Country:US
Practice Address - Phone:323-857-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily