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NPI Code Detail

MEDICARE: CYNTHIA Y MEDINA

MEDICARE: CYNTHIA Y 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
1225X00000XOccupational Therapist3014NM

General Provider Information

NPI Number : 1407245590
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYNTHIA Y MEDINA
Provider Business Mailing Address
First Line : 1831 CAMINO DEL LLANO
Second Line :
City : BELEN
State : NM
Zip : 87002-2619
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1831 CAMINO DEL LLANO
Second Line :
City : BELEN
State : NM
Zip : 87002-2619
Country : US
Telephone Number : 505-864-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2015
Last Update Date : 01/13/2015

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Directions to “ CYNTHIA Y MEDINA ” Practice Location

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