1366500704 NPI number — MR. ROBERT SCOTT MEDIN MFCC MV17473 MFT

Table of content: MR. ROBERT SCOTT MEDIN MFCC MV17473 MFT (NPI 1366500704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366500704 NPI number — MR. ROBERT SCOTT MEDIN MFCC MV17473 MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDIN
Provider First Name:
ROBERT
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MFCC MV17473 MFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366500704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6579 MILTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAGALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-873-4955
Provider Business Mailing Address Fax Number:
530-895-6597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 COHASSET ROAD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-895-6650
Provider Business Practice Location Address Fax Number:
530-895-6597
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  MV17473 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: MV17473 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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