Provider Demographics
NPI:1194591248
Name:MEDINA, CYNTHIA YOLANDA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:YOLANDA
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 1:1708 LOUISVILLE CT
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-1860
Mailing Address - Country:US
Mailing Address - Phone:209-707-6996
Mailing Address - Fax:
Practice Address - Street 1:1708 LOUISVILLE CT
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-1860
Practice Address - Country:US
Practice Address - Phone:209-707-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA95167674163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse