Medina, Marisa Denise

Medina, Marisa Denise is an sole proprietor health care provider with primary practice located at 17343 Anastasia Ave , Fontana CA 92335-4933. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Medina, Marisa Denise can be contacted via phone (626) 201-6674.

Contact Information

Primary practice address
17343 Anastasia Ave Fontana CA 92335-4933
Phone: (626) 201-6674
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Clinical 1041C0700X LCSW127143 California

Profile Details

NPI number 1770757445
LBN Legal business name Medina, Marisa Denise
Credentials LCSW127143
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 14th, 2008
Last updated Jan 16th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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