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General NPI Number Information
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NPI Number | 1023736154
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Entity Type | Individual
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Provider Name | GABRIELA ALEJANDRA MEDINA LIMA ATC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 1705 S SAN FRANCISCO ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86011-2205
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Country | US
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Telephone | 928-523-5353
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Fax |
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Provider Business Mailing Address
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Address Line | 12758 FOLIAGE CT
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City | APPLE VALLEY
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State | MN
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Zip | 55124-7978
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Country | US
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Telephone | 754-304-7514
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATR-100208
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License Number State | AZ
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