Individual
MINDIE A MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
1005 E. MAIN ST, MEDFORD, OR 97504
(702) 420-9219
Mailing address
2190 DELTA WATERS RD, MEDFORD, OR 97504-4906
(702) 420-9219
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
OR
Other
Enumeration date
03/10/2014
Last updated
03/10/2014
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