Provider Demographics
NPI:1104913789
Name:MEDINA, CHRISTIAN LAMA (RPT)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:LAMA
Last Name:MEDINA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 N DIAMOND BAR BLVD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1039
Mailing Address - Country:US
Mailing Address - Phone:909-861-8211
Mailing Address - Fax:909-861-8055
Practice Address - Street 1:832 N DIAMOND BAR BLVD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1039
Practice Address - Country:US
Practice Address - Phone:909-861-8211
Practice Address - Fax:909-861-8055
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist