Provider Demographics
NPI:1962502724
Name:MEDINA, ZORAIDA
Entity Type:Individual
Prefix:
First Name:ZORAIDA
Middle Name:
Last Name: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:CALLE # 870
Mailing Address - Street 2:EDIF A APT. 3 RES. LOMA ALTA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-392-2585
Mailing Address - Fax:
Practice Address - Street 1:B8 CALLE MILAGROS CABEZAS
Practice Address - Street 2:URB. CAROLINA ALTA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-7108
Practice Address - Country:US
Practice Address - Phone:787-392-2585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4220183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4220OtherLICENCIA