Individual
ALEXANDER MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAS. BS.
Contact information
Practice address
509 E 13TH ST, PUEBLO, CO 81001-2940
(719) 546-6667
Mailing address
3112 ASTER ST, PUEBLO, CO 81005-3179
(719) 553-7172
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACC.0021158
CO
Other
Enumeration date
05/16/2024
Last updated
06/10/2024
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