Individual
MR. MARK MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1600 W 24TH ST, PUEBLO, CO 81003-1411
(719) 546-4000
Mailing address
3115 FRANKLIN AVE, PUEBLO, CO 81008-1331
(719) 248-5043
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN.1658172
CO
Other
Enumeration date
09/05/2022
Last updated
09/05/2022
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