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1982107447
MARIO MEDINA VAZQUEZ
ELK GROVE, CA
NPI
1982107447
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
(Licence: CA 1746902)
Enumeration Date
2018-03-12
Last Update Date
2018-03-12
Business Address
MARIO MEDINA VAZQUEZ
7801 LAGUNA BLVD STE 100
ELK GROVE, CA 95758-7954
Phone number: 209-572-2589
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Mailing Address
MARIO MEDINA VAZQUEZ
PO BOX 5157
MODESTO, CA 95352-5157
Phone number: 209-572-2589
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