Provider Demographics
NPI:1326689886
Name:MEDINA, MARIANELA
Entity Type:Individual
Prefix:
First Name:MARIANELA
Middle Name:
Last Name:MEDINA
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 1:900 W 49TH ST STE 332
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3489
Mailing Address - Country:US
Mailing Address - Phone:786-786-5305
Mailing Address - Fax:786-789-5315
Practice Address - Street 1:900 W 49TH ST STE 332
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3489
Practice Address - Country:US
Practice Address - Phone:786-786-5305
Practice Address - Fax:786-789-5315
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ11061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist