Provider Demographics
NPI:1750869350
Name:MEDINA, YADYMARIZ (SLP)
Entity type:Individual
Prefix:
First Name:YADYMARIZ
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CALLE GUATEMALA
Mailing Address - Street 2:PARCELAS LA DOLORES
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-364-3511
Mailing Address - Fax:
Practice Address - Street 1:204 CALLE GUATEMALA
Practice Address - Street 2:PARCELAS LA DOLORES
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-364-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist