Provider Demographics
NPI:1619779543
Name:MEDINA, ESMERALDA IVETTE
Entity type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:IVETTE
Last Name:MEDINA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ESMERALDA
Other - Middle Name:IVETTE
Other - Last Name:DE LA TORRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:EL CAJON CTC 234 N. MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020
Mailing Address - Country:US
Mailing Address - Phone:619-579-8373
Mailing Address - Fax:
Practice Address - Street 1:EL CAJON CTC 234 N. MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-9202
Practice Address - Country:US
Practice Address - Phone:619-579-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA706834164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse