Most Relevant Information
Provider Data
| NPI Number: | 1003454307 |
| Provider Name: | MANUEL J MEDINA |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | 18-56801 |
Most Important Dates
| Enumeration Date: | 12/17/2019 |
| Last Updated: | 12/17/2019 |
Provider Practice Location
2700 S SHARTEL AVE
OKLAHOMA CITY
OK
731092234
Practice Location Phone/Fax
| Phone: | 4057522264 |
| Fax: |
Provider Mailing Location
13404 N MERIDIAN AVE
OKLAHOMA CITY
OK
731208311
Provider Mailing Phone/Fax
| Phone: | 4057522264 |
| Fax: |