Provider Demographics
NPI:1790033322
Name:MEDINA, SEANA B (LAC MSTCM)
Entity Type:Individual
Prefix:MISS
First Name:SEANA
Middle Name:B
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LAC MSTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S. CHERRY ST.
Mailing Address - Street 2:1-304
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246
Mailing Address - Country:US
Mailing Address - Phone:303-564-0505
Mailing Address - Fax:
Practice Address - Street 1:3545 S TAMARAC DR.
Practice Address - Street 2:STE #170
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237
Practice Address - Country:US
Practice Address - Phone:303-564-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001807171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist