Individual
GRACIELA MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
880 ANTHONY DR. STE 8A, LAS CRUCES, NM 88021
(575) 201-5134
(575) 201-5108
Mailing address
1320 S. SOLANO, LAS CRUCES, NM 88001
(575) 527-7900
(575) 571-4872
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18677037
—
NM
05
—
64153274
—
NM
Enumeration date
02/10/2010
Last updated
04/02/2014
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