Provider Demographics
NPI:1225928641
Name:MEDINA GONZALEZ DERMATOLOGY LLC
Entity type:Organization
Organization Name:MEDINA GONZALEZ DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:MEDINA GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-464-2544
Mailing Address - Street 1:2765 AVE HOSTOS STE 235
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-6390
Mailing Address - Country:US
Mailing Address - Phone:787-464-2544
Mailing Address - Fax:
Practice Address - Street 1:D80 CALLE C
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-2012
Practice Address - Country:US
Practice Address - Phone:787-400-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center