Healthcare Provider Details

I. General information

NPI: 1043462211
Provider Name (Legal Business Name): YESENIA MEDINA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 ENTERPRISE CTR STE 205
BOYNTON BEACH FL
33437-3761
US

IV. Provider business mailing address

2326 S CONGRESS AVE STE 1A
WEST PALM BEACH FL
33406-7652
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-5577
  • Fax: 561-275-2696
Mailing address:
  • Phone: 561-433-5577
  • Fax: 561-275-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS10520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: