Individual
ELISABET 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
(310) 398-5690
Mailing address
3031 S VERMONT AVE, LOS ANGELES, CA 90007-3033
(323) 791-8943
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
225400000X
Rehabilitation Practitioner
F1130881
CA
225400000X
Rehabilitation Practitioner
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2020
Last updated
07/03/2025
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