Provider Demographics
NPI:1851494181
Name:MEDINA, UBALDO (MD)
Entity Type:Individual
Prefix:DR
First Name:UBALDO
Middle Name:
Last Name:MEDINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 BRISAS DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-9820
Mailing Address - Country:US
Mailing Address - Phone:787-884-7207
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA NUMERO 2 KM. 40.2
Practice Address - Street 2:PLAZA JARDINES
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00694-1450
Practice Address - Country:US
Practice Address - Phone:787-855-0411
Practice Address - Fax:787-855-0285
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16600208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice