Provider Demographics
NPI:1841410172
Name:MEDINA, YOLANDA (RPHA)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:RPHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE. FONT MARTELLO
Mailing Address - Street 2:#124-126
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-852-0303
Mailing Address - Fax:787-850-6633
Practice Address - Street 1:AVE. FONT MARTELLO
Practice Address - Street 2:#124-126
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-0303
Practice Address - Fax:787-850-6633
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2963183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician