Healthcare Provider Details

I. General information

NPI: 1083870976
Provider Name (Legal Business Name): YIRAIMA E. MEDINA-BLASINI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 10/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA TITO CASTRO #917
PONCE PR
00733-6810
US

IV. Provider business mailing address

AVENIDA TITO CASTRO #917
PONCE PR
00733-6810
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2080
  • Fax:
Mailing address:
  • Phone: 787-844-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18422
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME124326
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: