Individual
MEDINA TAHIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
251 LLEWELLYN AVE, CAMPBELL, CA 95008-1940
(408) 379-3796
Mailing address
986 ALMADEN LAKE DR, SAN JOSE, CA 95123-5375
(408) 460-2652
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT35241
CA
Other
Enumeration date
06/16/2015
Last updated
06/16/2015
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