Provider Demographics
NPI:1841071446
Name:MEDINA, SUSIE (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-3642
Mailing Address - Country:US
Mailing Address - Phone:661-321-0234
Mailing Address - Fax:661-321-9856
Practice Address - Street 1:1010 1/2 S UNION AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-3642
Practice Address - Country:US
Practice Address - Phone:661-379-9571
Practice Address - Fax:661-321-9856
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker