Provider Demographics
NPI:1669929246
Name:MEDINA, ADRIAN MICHAEL (CNM)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:MICHAEL
Last Name:MEDINA
Suffix:
Gender:M
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 889442
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90088-9442
Mailing Address - Country:US
Mailing Address - Phone:559-603-7389
Mailing Address - Fax:
Practice Address - Street 1:2471 E FIR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0536
Practice Address - Country:US
Practice Address - Phone:559-881-6151
Practice Address - Fax:559-261-9324
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236532367A00000X
GURX0696163WX0003X
GUNP0163367A00000X
COAPN.0992465-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient