Medina, Lisa J

Medina, Lisa J is an individual health care provider with primary practice located at 2300 Grande Blvd Se , Rio Rancho NM 87124-1755. She recently has only one registered license in Dental Providers / Dental Hygienist, which is considered as her primary health care specialty. Medina, Lisa J can be contacted via phone (505) 896-7100.

Contact Information

Primary practice address
2300 Grande Blvd Se Rio Rancho NM 87124-1755
Phone: (505) 896-7100
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dental Hygienist 124Q00000X DH4346 New Mexico

Profile Details

NPI number 1093182446
LBN Legal business name Medina, Lisa J
Credentials Registered Dental Hygienist (RDH)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 1st, 2015
Last updated Apr 4th, 2018 - about 8 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 1093182446 NPPES
New Mexico MEDICAID 1093182446

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