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1609619592
IVAN MEDINA
SANTA ROSA, CA
NPI
1609619592
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2024-06-17
Last Update Date
2024-06-17
Business Address
IVAN MEDINA
2739 NAVAJO ST
SANTA ROSA, CA 95403-3223
Phone number: 707-331-3647
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Mailing Address
IVAN MEDINA
2739 NAVAJO ST
SANTA ROSA, CA 95403-3223
Phone number: 707-331-3647
Copy
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