Individual
DIANA MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2025 GALISTEO ST, SANTA FE, NM 87505-2101
(505) 995-4901
(505) 989-6426
Mailing address
2025 GALISTEO ST, SANTA FE, NM 87505-2101
(505) 995-4901
(505) 989-6426
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
91-PA07
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201006707
PRESBYTERIAN HEALTH PLANS
—
05
—
98151
—
NM
01
—
QMYPR0068422
MOLINA
—
Enumeration date
05/27/2006
Last updated
03/26/2013
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