Healthcare Provider Details

I. General information

NPI: 1184757411
Provider Name (Legal Business Name): MISS AMARILYS C MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 W 12TH AVE
HIALEAH FL
33012-4126
US

IV. Provider business mailing address

7535 W 8TH AVE
HIALEAH FL
33014-4007
US

V. Phone/Fax

Practice location:
  • Phone: 305-231-5151
  • Fax:
Mailing address:
  • Phone: 786-325-2096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA44858
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: