Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | 18456 | AZ |
Y | 225700000X | Massage Therapist | 18456 | AZ |
NPI | 1306481247 |
---|---|
Provider Name | Mrs. Dymphna I Medina |
First Address | Tucson, AZ 85713-6358 |
Second Address | Green Valley, AZ 85622-3546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2019 |
Last Update Date | 14/11/2019 |