Provider Demographics
NPI:1376032276
Name:MEDINA, GLADYS YURIKO (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:YURIKO
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:YURIKO
Other - Last Name:URENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:103 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3713
Mailing Address - Country:US
Mailing Address - Phone:203-323-6127
Mailing Address - Fax:
Practice Address - Street 1:103 W BROAD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3713
Practice Address - Country:US
Practice Address - Phone:203-323-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator