Basic Information
| Provider Information | |||||||||
| NPI: | 1265713762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEDINA | ||||||||
| FirstName: | ROCIO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 EMPIRE ST | ||||||||
| Address2: | SUITE 1500 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945335711 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1234 EMPIRE ST | ||||||||
| Address2: | SUITE 1500 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945335711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074264746 | ||||||||
| FaxNumber: | 7074194952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2011 | ||||||||
| LastUpdateDate: | 05/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT91292 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.