Provider Demographics
NPI:1316273212
Name:MEDINA, RUTH (BS)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23461 S POINTE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1547
Mailing Address - Country:US
Mailing Address - Phone:949-855-1556
Mailing Address - Fax:949-581-1295
Practice Address - Street 1:1841 S NINTH ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-3242
Practice Address - Country:US
Practice Address - Phone:714-517-8959
Practice Address - Fax:714-517-9247
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health