Provider Demographics
NPI:1710796305
Name:MEDINA, VIRGINIA ALEJANDRA
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ALEJANDRA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED INTERPRETER
Mailing Address - Street 1:1585 VIA ESTANCIA UNIT 301
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3758
Mailing Address - Country:US
Mailing Address - Phone:760-879-7771
Mailing Address - Fax:
Practice Address - Street 1:1585 VIA ESTANCIA UNIT 301
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3758
Practice Address - Country:US
Practice Address - Phone:760-879-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC023657171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter