Provider Demographics
NPI:1073173118
Name:MEDINA PENA, ANGELICA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:
Last Name:MEDINA PENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 COMMONWEALTH AVE APT 29
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-4212
Mailing Address - Country:US
Mailing Address - Phone:212-518-1434
Mailing Address - Fax:
Practice Address - Street 1:15 FRANCIS ST # A4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6105
Practice Address - Country:US
Practice Address - Phone:617-732-6829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program