Individual
AIDA MARLENE MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2550 E FOOTHILL BLVD, PASADENA, CA 91107-3406
(818) 244-7257
Mailing address
PO BOX 7481, BURBANK, CA 91510-7481
(818) 445-5211
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MFTI 53319
CA
106H00000X
Marriage & Family Therapist
—
CA
225400000X
Rehabilitation Practitioner
—
—
225C00000X
Rehabilitation Counselor
Primary
—
—
Other
Enumeration date
03/22/2007
Last updated
02/06/2014
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