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Mr. Ricardo Medina SR.
Peer Specialist in Miami, Oklahoma
NPI 1629526355

Ricardo Medina SR. is a Peer Specialist based in Joplin, OK. Ricardo Medina SR. practices in Miami, OK. The NPI Number for Ricardo Medina SR. is 1629526355 and holds a License No. (Oklahoma).

The current practice location address for Ricardo Medina SR. is 111 S Treaty Rd, Miami, OK and can be reached out via phone at 918-540-1522.

Location: 111 S Treaty Rd, Miami, OK, 64801-2465
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1629526355
Provider Name
Ricardo Medina SR.
Credential
Provider Entity Type
Individual
Gender
Male
Address
111 S Treaty Rd, Miami, OK, 64801-2465
Phone Number
918-540-1522
Fax Number
Provider Enumeration Date
09/11/2016
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
S202187064 01 TX DRIVERS LICENSE
institution
Provider Business Practice Location Address Details
Address
111 S Treaty Rd
City
Miami
State
Oklahoma
Zip
74354-5327
Phone Number
918-540-1522
Fax Number
person
Provider Business Mailing Address Details
Address
111 S Treaty Rd
City
Miami
State
Oklahoma
Zip
74354-5327
Phone Number
918-540-1522
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
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Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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