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Individual

LISA J MEDINA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RDH

Contact information

Practice address
2300 GRANDE BLVD SE, RIO RANCHO, NM 87124-1755
(505) 896-7100
Mailing address
2300 GRANDE BLVD SE, RIO RANCHO, NM 87124-1755
(505) 896-7100

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH4346
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1093182446
NM
Enumeration date
09/01/2015
Last updated
04/04/2018
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