Provider Demographics
NPI:1922203629
Name:BRITO MEDINA, CARMEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:
Last Name:BRITO MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:BRITO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8129
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960
Mailing Address - Country:US
Mailing Address - Phone:787-798-4592
Mailing Address - Fax:787-798-8237
Practice Address - Street 1:EDIFICIO MEDICO SANTA CRUZ #73
Practice Address - Street 2:SUITE 212
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-798-4592
Practice Address - Fax:787-798-8237
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR170282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17028OtherPUERTO RICO MEDICAL LICENSE