| Doctor Name: | MR. ANTONIO C MEDINA |
| NPI Number: | 1205009768 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MFT |
| License Number: | 104550 |
| Business Practice Address: | 14241 Firestone Blvd Suite 400 La Mirada, CA - 906385530 |
| Business Phone Number: | 3107132935 |
| Business Fax Number: | |
| Mailing Address: | 14506 Rosecrans Ave, LA MIRADA |
| State: | CA |
| Postal Code: | 906383743 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/04/2008 |
| NPI Last Update Date: | 02/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 104550 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |