Healthcare Provider Details

I. General information

NPI: 1073009056
Provider Name (Legal Business Name): JEANNIE PAOLA MEDINA PAEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 W COLONIAL DR STE 205
OCOEE FL
34761-4200
US

IV. Provider business mailing address

10125 W COLONIAL DR STE 205
OCOEE FL
34761-4200
US

V. Phone/Fax

Practice location:
  • Phone: 407-578-1241
  • Fax: 407-578-1242
Mailing address:
  • Phone: 407-578-1241
  • Fax: 407-578-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME147502
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: