Healthcare Provider Details

I. General information

NPI: 1205949153
Provider Name (Legal Business Name): YANIRA MEDINA CLAUDIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HF16 CALLE LIZZIE GRAHAM 7MA SECCIO LEVITTOWN
TOA BAJA PR
00949-3634
US

IV. Provider business mailing address

AC1 CALLE RIO ESPIRITU SANTO RIO HONDO
BAYAMON PR
00961-3229
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2935
  • Fax:
Mailing address:
  • Phone: 787-795-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15115
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: