Healthcare Provider Details

I. General information

NPI: 1841742525
Provider Name (Legal Business Name): KATHERINE MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NW 150TH AVE STE 2109
PEMBROKE PINES FL
33028-2870
US

IV. Provider business mailing address

1104 W 40TH PL
HIALEAH FL
33012-4190
US

V. Phone/Fax

Practice location:
  • Phone: 954-378-5381
  • Fax:
Mailing address:
  • Phone: 786-614-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: