Provider Demographics
NPI:1508498353
Name:MEDINA ROMAN, YASHIRA ANAIS (MD)
Entity Type:Individual
Prefix:
First Name:YASHIRA
Middle Name:ANAIS
Last Name:MEDINA ROMAN
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:U-2 CALLE GRANADILLA
Mailing Address - Street 2:VALLE ARRIBA HEIGHTS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:REGISTRAR OFFICE
Practice Address - Street 2:UNIVERSITY OF PUERTO RICO MEDICAL SCIENCE CAMPUS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5067
Practice Address - Country:US
Practice Address - Phone:787-763-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16288208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice