Individual
MITAS MOINA BALBIN MEDRANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20508 W DANIEL PL, BUCKEYE, AZ 85396-3649
(650) 580-3503
(623) 776-2813
Mailing address
20508 W DANIEL PL, BUCKEYE, AZ 85396-3649
(650) 580-3503
(623) 776-2813
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
23719
CA
225100000X
Physical Therapist
Primary
7029
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
335861
—
AZ
Enumeration date
01/19/2006
Last updated
04/13/2017
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