Provider Demographics
NPI:1073888988
Name:MEDINA-LAGO, ANGELA J
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:J
Last Name:MEDINA-LAGO
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 1:7537 SUN TREE CIR APT 178
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-6166
Mailing Address - Country:US
Mailing Address - Phone:407-962-7953
Mailing Address - Fax:
Practice Address - Street 1:7537 SUN TREE CIR APT 178
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-6166
Practice Address - Country:US
Practice Address - Phone:407-962-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling