Provider Demographics
NPI:1497755037
Name:MEDINA-CAPOTE, MARIA E (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:MEDINA-CAPOTE
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 1:10240 SW 56TH ST
Mailing Address - Street 2:ST #108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7071
Mailing Address - Country:US
Mailing Address - Phone:305-275-6070
Mailing Address - Fax:305-275-5002
Practice Address - Street 1:10240 SW 56TH ST
Practice Address - Street 2:ST #108
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7071
Practice Address - Country:US
Practice Address - Phone:305-275-6070
Practice Address - Fax:305-275-5002
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME068713208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378378200Medicaid
FL378378200Medicaid