Provider Demographics
NPI:1831681741
Name:MEDINA, DULZAIDA (RN BSN CDE)
Entity type:Individual
Prefix:
First Name:DULZAIDA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:RN BSN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 5 BOX 8992
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9237
Mailing Address - Country:US
Mailing Address - Phone:787-602-6371
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE 1
Practice Address - Street 2:URB DIAZ GALATEO CENTRO
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-9237
Practice Address - Country:US
Practice Address - Phone:787-602-6371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34597163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator