Most Relevant Information
Provider Data
| NPI Number: | 1003453572 |
| Provider Name: | AMY MEDINA |
| Entity Type: | Individual |
| Taxonomy Code: | 247200000X |
| Specialty: | Technician, Other |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/04/2019 |
| Last Updated: | 12/04/2019 |
Provider Practice Location
20331 FLANAGAN RD
TRABUCO CANYON
CA
92679
Practice Location Phone/Fax
| Phone: | 8185828832 |
| Fax: |
Provider Mailing Location
8140 SUNLAND BLVD
SUN VALLEY
CA
913523948
Provider Mailing Phone/Fax
| Phone: | 8185828832 |
| Fax: |