Provider Demographics
NPI:1154304178
Name:MEDINA, ANA L (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:L
Last Name:MEDINA
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 1:12 CALLE 1
Mailing Address - Street 2:EXT ALTURAS DE SAN PATRICIO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3128
Mailing Address - Country:US
Mailing Address - Phone:787-614-5440
Mailing Address - Fax:787-792-2076
Practice Address - Street 1:572 DE DIEGO
Practice Address - Street 2:ESQUINA MILAN
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-754-9586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5641208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics