Healthcare Provider Details

I. General information

NPI: 1861318586
Provider Name (Legal Business Name): VICTORIA ALVARADO-MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16481 PERSIMMON BLVD W
WESTLAKE FL
33470
US

IV. Provider business mailing address

16481 PERSIMMON BLVD W
WESTLAKE FL
33470
US

V. Phone/Fax

Practice location:
  • Phone: 561-273-1071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSI45605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: