Individual
KEITH ALLEN MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
8045 N 47TH AVE, GLENDALE, AZ 85302-6402
(623) 435-6300
(623) 435-6369
Mailing address
8045 N 47TH AVE, GLENDALE, AZ 85302-6402
(623) 435-6300
(623) 435-6369
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201020
AZ
Other
Enumeration date
08/05/2021
Last updated
08/05/2021
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