Provider Demographics
NPI:1922534858
Name:ANAMPA MEDINA, DINA
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:ANAMPA 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 1:15851 SW 172ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-1312
Mailing Address - Country:US
Mailing Address - Phone:786-654-9893
Mailing Address - Fax:
Practice Address - Street 1:14433 SW 93RD TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1055
Practice Address - Country:US
Practice Address - Phone:786-620-6532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
FLRBT-21-157466106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No253Z00000XAgenciesIn Home Supportive Care