Provider Demographics
NPI:1659697944
Name:MIRO MEDINA, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:MIRO 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:A4 CALLE 2 MANSIONES DE GARDEN HILLS
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-943-8000
Mailing Address - Fax:
Practice Address - Street 1:100 CARR. 165 TORRE 1 SUITE C-107
Practice Address - Street 2:CENTRO INTERNACIONAL DE MERCADEO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-999-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558OtherLICENSE