Provider Demographics
NPI:1265707574
Name:MEDINA, AYDA MARITZA
Entity type:Individual
Prefix:
First Name:AYDA
Middle Name:MARITZA
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 1:340 N. SAM HOUSTON PWY E.
Mailing Address - Street 2:SUITE199
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3325
Mailing Address - Country:US
Mailing Address - Phone:281-822-0808
Mailing Address - Fax:
Practice Address - Street 1:340 N SAM HOUSTON PKWY E
Practice Address - Street 2:SUITE199
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3305
Practice Address - Country:US
Practice Address - Phone:281-822-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist