Provider Demographics
NPI:1710064183
Name:MEDINA, CYNTHIA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LYNN
Last Name:MEDINA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14678 N DEL WEBB BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-2137
Mailing Address - Country:US
Mailing Address - Phone:623-933-8289
Mailing Address - Fax:623-933-2596
Practice Address - Street 1:14678 N DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2137
Practice Address - Country:US
Practice Address - Phone:623-933-8289
Practice Address - Fax:623-933-2596
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH56178Medicare UPIN
NY42V703Medicare ID - Type Unspecified