Healthcare Provider Details

I. General information

NPI: 1306597240
Provider Name (Legal Business Name): MARIA DANIELA CUMACHE MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23426 US HIGHWAY 33
ELKHART IN
46517-3600
US

IV. Provider business mailing address

424 JOHNSTON ST APT 3
GOSHEN IN
46528-2766
US

V. Phone/Fax

Practice location:
  • Phone: 574-387-4309
  • Fax:
Mailing address:
  • Phone: 360-401-9418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: