Individual
IMELDA MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4920 AVALON BLVD, LOS ANGELES, CA 90011-4004
(323) 235-5035
Mailing address
3747 W 107TH ST, INGLEWOOD, CA 90303-1933
(310) 213-6258
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
243336
CA
Other
Enumeration date
10/28/2020
Last updated
10/28/2020
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