Provider Demographics
NPI:1922717974
Name:MEDINA, GLORIA MARIA
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:MARIA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:MARIA
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10000
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-9601
Mailing Address - Country:US
Mailing Address - Phone:717-992-5741
Mailing Address - Fax:
Practice Address - Street 1:11 PRADERAS DEL PLATA
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3159
Practice Address - Country:US
Practice Address - Phone:717-992-5741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR44878633747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider