Individual
DIAMOND MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8268 164TH ST, JAMAICA, NY 11432-1121
(718) 883-3070
Mailing address
8268 164TH ST, JAMAICA, NY 11432-1121
(718) 883-3070
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
020226
NY
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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