Healthcare Provider Details

I. General information

NPI: 1790131654
Provider Name (Legal Business Name): MRS. BRAULIA ARLETH ALEJANDRINA MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2254 W BROOK ST
YUMA AZ
85364-4564
US

IV. Provider business mailing address

4336 W 21ST LN
YUMA AZ
85364-5843
US

V. Phone/Fax

Practice location:
  • Phone: 928-550-0013
  • Fax:
Mailing address:
  • Phone: 928-920-7452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number7614829
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number7614829
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: