Provider Demographics
NPI:1508746959
Name:MEDINA, ESTEBAN (SLP)
Entity type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:
Last Name:MEDINA
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PORTER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1525
Mailing Address - Country:US
Mailing Address - Phone:925-743-3322
Mailing Address - Fax:925-743-3733
Practice Address - Street 1:210 PORTER DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1525
Practice Address - Country:US
Practice Address - Phone:925-743-3322
Practice Address - Fax:925-743-3733
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP26640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty