Provider Demographics
NPI:1760861744
Name:AROCHO-MEDINA, ELISA RAQUEL
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:RAQUEL
Last Name:AROCHO-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 1:710 AVENIDA CUARTA APT 103
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-7558
Mailing Address - Country:US
Mailing Address - Phone:407-729-8717
Mailing Address - Fax:
Practice Address - Street 1:710 AVENIDA CUARTA APT 103
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-7558
Practice Address - Country:US
Practice Address - Phone:407-729-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist