Individual
AUDREY MORENO MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4760 SEPULVEDA BLVD, CULVER CITY, CA 90230-4820
(310) 390-6612
Mailing address
556 S FAIR OAKS AVE STE 101, PASADENA, CA 91105-2657
(626) 788-2831
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
141738
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952562910
PSYCHOTHERAPY
CA
Enumeration date
07/28/2022
Last updated
05/07/2024
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