Healthcare Provider Details

I. General information

NPI: 1871361105
Provider Name (Legal Business Name): MEDINA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 E 10TH ST
HIALEAH FL
33010-3636
US

IV. Provider business mailing address

766 E 10TH ST
HIALEAH FL
33010-3636
US

V. Phone/Fax

Practice location:
  • Phone: 786-398-1326
  • Fax: 786-590-1033
Mailing address:
  • Phone: 786-398-1326
  • Fax: 786-590-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: YURITZA MEDINA RAMIREZ
Title or Position: CEO
Credential: DNP, PMHNP-BC, FNP-C
Phone: 786-398-1326