Provider Demographics
NPI:1790131654
Name:MEDINA, BRAULIA ARLETH ALEJANDRINA
Entity Type:Individual
Prefix:MRS
First Name:BRAULIA
Middle Name:ARLETH ALEJANDRINA
Last Name: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 1:4336 W 21ST LN
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-5843
Mailing Address - Country:US
Mailing Address - Phone:928-920-7452
Mailing Address - Fax:
Practice Address - Street 1:2254 W BROOK ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4564
Practice Address - Country:US
Practice Address - Phone:928-550-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7614829253J00000X, 385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No253J00000XAgenciesFoster Care Agency