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MR. NICHOLAS DEMECIO MEDINA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
A.T.C.

Contact information

Practice address
7007 JEFFERSON ST NE STE C, ALBUQUERQUE, NM 87109-4450
(505) 821-4325
Mailing address
7007 JEFFERSON ST NE STE C, ALBUQUERQUE, NM 87109-4450

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
493
NM

Other

Enumeration date
08/12/2011
Last updated
08/12/2011
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