Individual
MISS JACQUELINE FRANCINE MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CAC II
Contact information
Practice address
2265 LAVA LN, ALAMOSA, CO 81101-3578
(719) 589-5176
Mailing address
1301 ROSS AVE, ALAMOSA, CO 81101-3541
(719) 937-3394
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
7185
CO
Other
Enumeration date
04/19/2011
Last updated
04/19/2011
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