Medina, Diana

Medina, Diana is an individual health care provider with primary practice located at 2025 Galisteo St , Santa Fe NM 87505-2101. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Medina, Diana can be contacted via phone (505) 995-4901.

Contact Information

Primary practice address
2025 Galisteo St Santa Fe NM 87505-2101
Phone: (505) 995-4901
Fax: (505) 989-6426
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 91-PA07 New Mexico

Profile Details

NPI number 1104873082
LBN Legal business name Medina, Diana
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date May 27th, 2006
Last updated Mar 26th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104873082 NPPES
Other QMYPR0068422 MOLINA
Other 201006707 MOLINA
MEDICAID 98151 MOLINA

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