Healthcare Provider Details

I. General information

NPI: 1831032085
Provider Name (Legal Business Name): MARTHA E GALICIA MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 38TH AVE W APT 514
BRADENTON FL
34205-5090
US

IV. Provider business mailing address

2200 38TH AVE W APT 514
BRADENTON FL
34205-5090
US

V. Phone/Fax

Practice location:
  • Phone: 941-567-8120
  • Fax:
Mailing address:
  • Phone: 941-567-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-528-147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: