Provider Demographics
NPI:1417374091
Name:MEDINA, CAROLINA
Entity Type:Individual
Prefix:
First Name:CAROLINA
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 1:50 CALLE TAFT APT 7A
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:US
Mailing Address - Phone:787-459-6582
Mailing Address - Fax:
Practice Address - Street 1:50 CALLE TAFT
Practice Address - Street 2:APT 7A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1270
Practice Address - Country:US
Practice Address - Phone:787-459-6582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5491103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling