Individual
JENNYFER MELISSA MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
995 GATEWAY CENTER WAY STE 300, SAN DIEGO, CA 92102-4550
(619) 398-2156
(619) 398-2168
Mailing address
995 GATEWAY CENTER WAY STE 300, SAN DIEGO, CA 92102-4550
(619) 398-2156
(619) 398-2168
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/23/2019
Last updated
09/23/2019
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