Provider Demographics
NPI:1720565104
Name:MEDINA ROJAS, MAYDELIN I
Entity Type:Individual
Prefix:
First Name:MAYDELIN
Middle Name:
Last Name:MEDINA ROJAS
Suffix:I
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 1:10511 SW 145TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2934
Mailing Address - Country:US
Mailing Address - Phone:786-702-1893
Mailing Address - Fax:
Practice Address - Street 1:9290 HAMMOCKS BLVD STE 401
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1347
Practice Address - Country:US
Practice Address - Phone:561-305-6971
Practice Address - Fax:786-913-7034
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician