Provider Demographics
NPI:1952395857
Name:MEDINA-ROQUE, XENIA (DC)
Entity Type:Individual
Prefix:MRS
First Name:XENIA
Middle Name:
Last Name:MEDINA-ROQUE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MENDEZ VIGO
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731
Mailing Address - Country:US
Mailing Address - Phone:787-848-6539
Mailing Address - Fax:787-848-6539
Practice Address - Street 1:37 MENDEZ VIGO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-848-6539
Practice Address - Fax:787-848-6539
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
7310384OtherHUMANA
5473OtherIMC
601609OtherMMM
233007OtherPREFERRED
35105OtherSSS
5473OtherIMC
7310384OtherHUMANA