Provider Demographics
NPI:1760465801
Name:MEDINA, MARIA A (REGISTER NURSE)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:A
Last Name:MEDINA
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:CALLE 5 #101
Mailing Address - Street 2:HILL BROTHERS
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-764-7678
Mailing Address - Fax:787-764-9904
Practice Address - Street 1:AVE 65 INFANTERIA KL 34
Practice Address - Street 2:BARRIO SABANA LLANA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-767-7676
Practice Address - Fax:787-764-9904
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR15838163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice