Individual
JUAN MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
275 2ND ST FL 3, ELIZABETH, NJ 07206-2058
(973) 710-7677
Mailing address
275 2ND ST FL 3, ELIZABETH, NJ 07206-2058
(973) 710-7677
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
26NP0635110
NJ
Other
Enumeration date
08/21/2016
Last updated
08/21/2016
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