Provider Demographics
NPI:1033450606
Name:MEDINA, GILCA I
Entity Type:Individual
Prefix:
First Name:GILCA
Middle Name:I
Last Name:MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BARRIADA MARIN
Mailing Address - Street 2:CALLE PRINCIPAL 351
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION BUSO
Practice Address - Street 2:CARRETERA 3 NUMERO 443 SUITE 4
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-2828
Practice Address - Fax:787-852-4622
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07270183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician