Provider Demographics
NPI:1346252566
Name:MEDINA, LUZ (MD)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:
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 1:99 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2200
Mailing Address - Country:US
Mailing Address - Phone:808-249-8862
Mailing Address - Fax:808-249-8870
Practice Address - Street 1:99 S MARKET ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2200
Practice Address - Country:US
Practice Address - Phone:808-249-8862
Practice Address - Fax:808-249-8870
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50266207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD-14001OtherMEDICAL LICENSE
HIG15052Medicare UPIN
HIH102047Medicare PIN