Provider Demographics
NPI:1467214148
Name:MEDINA DE JESUS, JOSHUA ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALEXANDER
Last Name:MEDINA DE JESUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 DUNCAN LOOP S APT 205
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-1303
Mailing Address - Country:US
Mailing Address - Phone:787-619-4011
Mailing Address - Fax:
Practice Address - Street 1:1350 E MARKET ST FL 7
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6608
Practice Address - Country:US
Practice Address - Phone:330-759-2511
Practice Address - Fax:330-841-9645
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program