Provider Demographics
NPI:1922419928
Name:MEDINA, RITA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:ELIZABETH
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:ELIZABETH
Other - Last Name:MEDINA VEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-214-3531
Mailing Address - Fax:928-814-9529
Practice Address - Street 1:2418 N OAK ST STE B2
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2576
Practice Address - Country:US
Practice Address - Phone:229-433-1838
Practice Address - Fax:928-814-9529
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88496207RI0200X
IL036142211207RI0200X
AZ58329207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease