Individual
ERICA DIANE MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1090 GOAT SPRINGS ROAD, TAOS, NM 87571
(575) 758-6966
(575) 751-5211
Mailing address
P O BOX 310001-0670, PASADENA, CA 91110-0670
(575) 758-6966
(575) 751-5211
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH4180
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
K3543
—
NM
Enumeration date
11/01/2018
Last updated
11/01/2018
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