Provider Demographics
NPI:1093067696
Name:MEDINA RIVERA, BELINDA (MSPHL)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:
Last Name:MEDINA RIVERA
Suffix:
Gender:F
Credentials:MSPHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MONTE CLARO PLAZA 32
Mailing Address - Street 2:MP 20
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3574
Mailing Address - Country:US
Mailing Address - Phone:787-410-7191
Mailing Address - Fax:
Practice Address - Street 1:PLAZA 32 MONTE CLARO
Practice Address - Street 2:MP-20
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-0000
Practice Address - Country:US
Practice Address - Phone:787-410-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR977235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist