Individual
MARK J MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSW
Contact information
Practice address
2301 7TH ST STE A, LAS VEGAS, NM 87701-4966
(505) 454-8079
Mailing address
105 PASEO DEL CANON W STE A, TAOS, NM 87571-6943
(575) 737-5533
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/21/2024
Last updated
05/21/2024
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