Provider Demographics
NPI:1093589343
Name:MEDINA ARENCIBIA, ARIAMNA
Entity Type:Individual
Prefix:
First Name:ARIAMNA
Middle Name:
Last Name:MEDINA ARENCIBIA
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 1:1708 NW 78TH WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-0932
Mailing Address - Country:US
Mailing Address - Phone:704-977-6980
Mailing Address - Fax:
Practice Address - Street 1:1708 NW 78TH WAY
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-0932
Practice Address - Country:US
Practice Address - Phone:704-977-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-283633106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician