Provider Demographics
NPI:1538615851
Name:MEDINA, ZAIRA GUADALUPE (LVN)
Entity type:Individual
Prefix:
First Name:ZAIRA
Middle Name:GUADALUPE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24736 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-1708
Mailing Address - Country:US
Mailing Address - Phone:661-644-7520
Mailing Address - Fax:805-655-5974
Practice Address - Street 1:350 HILLMONT AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1651
Practice Address - Country:US
Practice Address - Phone:805-233-7750
Practice Address - Fax:805-653-5974
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN682493164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse