Provider Demographics
NPI:1982300943
Name:MEDINA LOPEZ, ELEYNIE MILAINE
Entity Type:Individual
Prefix:MISS
First Name:ELEYNIE
Middle Name:MILAINE
Last Name:MEDINA LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CALLE VICTORIA
Mailing Address - Street 2:BO. LAVADERO
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660
Mailing Address - Country:US
Mailing Address - Phone:939-216-2938
Mailing Address - Fax:
Practice Address - Street 1:128 CALLE VICTORIA
Practice Address - Street 2:BO. LAVADERO
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:939-216-2938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR76964163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse