Individual
MISS GRACIELA REBECA MEDINA II
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7352 MEADE CT, FONTANA, CA 92336-5439
(909) 613-0106
Mailing address
7352 MEADE CT, FONTANA, CA 92336-5439
(909) 435-1376
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
88142
CA
Other
Enumeration date
11/25/2020
Last updated
11/25/2020
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