Provider Demographics
NPI:1982741815
Name:MEDINA MENDEZ, LISAIDA (MT,ASCP)
Entity Type:Individual
Prefix:MRS
First Name:LISAIDA
Middle Name:
Last Name:MEDINA MENDEZ
Suffix:
Gender:F
Credentials:MT,ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0780
Mailing Address - Country:US
Mailing Address - Phone:787-857-2246
Mailing Address - Fax:787-857-1852
Practice Address - Street 1:8 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1776
Practice Address - Country:US
Practice Address - Phone:787-857-2246
Practice Address - Fax:787-857-1852
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR232291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory