Provider Demographics
NPI:1346328010
Name:MEDINA GONZALEZ, DEBBIE ANN (OPTHOMETRIC, OD)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:ANN
Last Name:MEDINA GONZALEZ
Suffix:
Gender:F
Credentials:OPTHOMETRIC, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDIFICIO MEDICAL EMPORIUM SUITE 107
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-834-2627
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO MEDICAL EMPORIUM SUITE 107
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist