Provider Demographics
NPI:1649060427
Name:MEDINA BARRUECO, YUNIOR
Entity type:Individual
Prefix:
First Name:YUNIOR
Middle Name:
Last Name:MEDINA BARRUECO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6065 NW 186TH ST APT 207
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6071
Mailing Address - Country:US
Mailing Address - Phone:786-805-8745
Mailing Address - Fax:
Practice Address - Street 1:6065 NW 186TH ST APT 207
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6071
Practice Address - Country:US
Practice Address - Phone:786-805-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11039299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily