Provider Demographics
NPI:1609651587
Name:MEDINA, MARIBEL
Entity Type:Individual
Prefix:
First Name:MARIBEL
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 1:8060 NW 10TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2868
Mailing Address - Country:US
Mailing Address - Phone:502-345-6663
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 80.4 BO SAN DANIEL
Practice Address - Street 2:SECTOR LAS CANELAS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00614-4050
Practice Address - Country:US
Practice Address - Phone:787-878-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030584367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered