Provider Demographics
NPI:1659811198
Name:MEDINA, RICARDO H (POLYGRAPH EXAMINER)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:H
Last Name:MEDINA
Suffix:
Gender:M
Credentials:POLYGRAPH EXAMINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NW IRVING ST APT 709
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 NW IRVING ST APT 709
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2260
Practice Address - Country:US
Practice Address - Phone:360-977-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR84179174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR84179OtherOREGON POLYGRAPH EXAMINER TRAINEE LICENSE