Provider Demographics
NPI:1790315489
Name:MEDINA, KEISHLA (MPHE)
Entity Type:Individual
Prefix:
First Name:KEISHLA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MPHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION LOS SUENOS #65
Mailing Address - Street 2:CIUDAD JARDIN
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-696-8888
Mailing Address - Fax:
Practice Address - Street 1:AVE. RAFAEL CORDERO, ESQUINA TROCHE
Practice Address - Street 2:APT. 1025
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-745-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1025174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator