Provider Demographics
NPI:1376672253
Name:MEDINA, MARTA (MD)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HUMACAO MEDICAL PLAZA AVE. FONT MARTELO 53 SUITE 203
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-285-1270
Mailing Address - Fax:787-285-1970
Practice Address - Street 1:HUMACAO MEDICAL PLAZA AVE. FONT MARTELO 53 SUITE 203
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-285-1270
Practice Address - Fax:787-285-1970
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR125172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH82243Medicare UPIN