Healthcare Provider Details

I. General information

NPI: 1851267504
Provider Name (Legal Business Name): JULIETTE MEDINA DE LA NUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 W 20TH AVE APT 314
HIALEAH FL
33012-6145
US

IV. Provider business mailing address

6215 W 20TH AVE APT 314
HIALEAH FL
33012-6145
US

V. Phone/Fax

Practice location:
  • Phone: 786-939-4172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: