Provider Demographics
NPI:1033802582
Name:MEDINA, MARGARITA (MHA)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 N PINE ISLAND RD APT 304
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7350
Mailing Address - Country:US
Mailing Address - Phone:201-253-5115
Mailing Address - Fax:
Practice Address - Street 1:3110 N PINE ISLAND RD APT 304
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7350
Practice Address - Country:US
Practice Address - Phone:201-253-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health