Individual
EDUARDO MEDINA PALACIOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
1233 SHERMAN DR, LONGMONT, CO 80501-6133
(720) 449-6676
Mailing address
1225 W PROSPECT RD APT T68, FORT COLLINS, CO 80526-5687
(970) 617-0090
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8144229
—
CO
Enumeration date
05/10/2021
Last updated
05/10/2021
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