Individual
ANDREA CRYSTAL MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
41 E FOOTHILL BLVD STE 102, ARCADIA, CA 91006-2361
(626) 701-4249
Mailing address
41 E FOOTHILL BLVD STE 102, ARCADIA, CA 91006-2361
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
84732
CA
1041C0700X
Clinical Social Worker
Primary
99958
CA
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84732
BBS
CA
Enumeration date
11/19/2018
Last updated
06/04/2021
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