MEDICARE: LIANA MEDINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	2061	NM

General Provider Information

NPI Number	:	1194653816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANA MEDINA

Provider Business Mailing Address
First Line	:	4320 BOGART LN
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-5507
Country	:	US
Telephone Number	:	505-584-0134
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 E IDAHO AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-4703
Country	:	US
Telephone Number	:	505-584-0134
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “ LIANA MEDINA ” Practice Location

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