Provider Demographics
NPI:1841928975
Name:BERRIOS, MEDELINE (ANESTHESIA, CRNA)
Entity type:Individual
Prefix:MISS
First Name:MEDELINE
Middle Name:
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:ANESTHESIA, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 75 BOX 1708
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9508
Mailing Address - Country:US
Mailing Address - Phone:787-475-4187
Mailing Address - Fax:
Practice Address - Street 1:686 STREET KM10.3
Practice Address - Street 2:APARTMENT 129 EDF 4
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-9761
Practice Address - Country:US
Practice Address - Phone:787-475-4187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101242367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered