Healthcare Provider Details

I. General information

NPI: 1982529889
Provider Name (Legal Business Name): YHACIEL SARAI MEDINA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4961 TESLA DR
BOWIE MD
20715-4405
US

IV. Provider business mailing address

7901 TOLKIN CT
BOWIE MD
20720-4432
US

V. Phone/Fax

Practice location:
  • Phone: 240-687-2606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: