Provider Demographics
NPI:1922682723
Name:MEDAL, MARIA BELEN (CNM)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:BELEN
Last Name:MEDAL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12613 SW 224TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-6329
Mailing Address - Country:US
Mailing Address - Phone:786-201-6660
Mailing Address - Fax:
Practice Address - Street 1:8200 SW 117TH AVE STE 304
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4826
Practice Address - Country:US
Practice Address - Phone:305-203-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007912367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife