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Individual

MR. EDUARDO MEDINA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RDA

Contact information

Practice address
8454 VICTORIA AVE APT C, SOUTH GATE, CA 90280-2364
(818) 445-1201
Mailing address
8454 VICTORIA AVE APT C, SOUTH GATE, CA 90280-2364
(818) 445-1201

Taxonomy

Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
92794
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
92794
CA
Enumeration date
05/12/2021
Last updated
05/12/2021
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