Provider Demographics
NPI:1861030629
Name:PINEDA MEDINA, JADZIA CARINA
Entity Type:Individual
Prefix:
First Name:JADZIA
Middle Name:CARINA
Last Name:PINEDA 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 1:178 MAUJER ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-1348
Mailing Address - Country:US
Mailing Address - Phone:347-661-6543
Mailing Address - Fax:
Practice Address - Street 1:178 MAUJER ST APT 4C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-1348
Practice Address - Country:US
Practice Address - Phone:347-661-6543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant