Provider Demographics
NPI:1568266823
Name:MEDINA, MONICA ROSE
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ROSE
Last Name:MEDINA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 N BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-3808
Mailing Address - Country:US
Mailing Address - Phone:559-579-1744
Mailing Address - Fax:
Practice Address - Street 1:4141 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-3808
Practice Address - Country:US
Practice Address - Phone:559-579-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator