Individual
BENJAMIN MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5935 VAN NUYS BLVD, VAN NUYS, CA 91401-3624
(818) 285-1900
(181) 285-1906
Mailing address
PO BOX 921015, SYLMAR, CA 91392-1015
(818) 285-1900
(818) 285-1906
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
071425-II
CA
Other
Enumeration date
06/08/2011
Last updated
06/08/2011
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