Individual
CAMILLA MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1315 AMOS ST, DALLAS, TX 75212-5202
(214) 773-2879
Mailing address
1315 AMOS ST, DALLAS, TX 75212-5202
(214) 773-2879
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/20/2017
Last updated
10/20/2017
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