Provider Demographics
NPI:1972342798
Name:MEDINA, FROILAN PADUA (RN, BSN, PHN)
Entity type:Individual
Prefix:
First Name:FROILAN
Middle Name:PADUA
Last Name:MEDINA
Suffix:
Gender:M
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:FROILAN
Other - Middle Name:MUNOZ
Other - Last Name:PADUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN, PHN
Mailing Address - Street 1:28310 ROADSIDE DR STE 239
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4965
Mailing Address - Country:US
Mailing Address - Phone:818-254-9448
Mailing Address - Fax:
Practice Address - Street 1:28310 ROADSIDE DR STE 239
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4965
Practice Address - Country:US
Practice Address - Phone:818-254-9448
Practice Address - Fax:562-348-1017
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA700924163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse