Healthcare Provider Details

I. General information

NPI: 1477433118
Provider Name (Legal Business Name): MARIA RICHIEZ MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5449 S SEMORAN BLVD STE 19B
ORLANDO FL
32822-1778
US

IV. Provider business mailing address

81 TROTTERS CIR
KISSIMMEE FL
34743-7729
US

V. Phone/Fax

Practice location:
  • Phone: 407-723-5264
  • Fax:
Mailing address:
  • Phone: 407-910-7629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH33484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: