Provider Demographics
NPI:1295603306
Name:MEDINA PACHECO, CAMILA ISABEL
Entity type:Individual
Prefix:
First Name:CAMILA
Middle Name:ISABEL
Last Name:MEDINA PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAMILA
Other - Middle Name:ISABEL
Other - Last Name:SLOAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2518 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8730
Mailing Address - Country:US
Mailing Address - Phone:850-736-9390
Mailing Address - Fax:
Practice Address - Street 1:307 N UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-3053
Practice Address - Country:US
Practice Address - Phone:251-445-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-29
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program