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General NPI Number Information
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NPI Number | 1073818761
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Entity Type | Organization
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Legal Business Name | YESENIA MEDINA DO PA
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 11373 SW 211TH ST
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City | MIAMI
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State | FL
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Zip | 33189-2245
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Country | US
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Telephone | 305-234-0009
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Fax | 305-234-8688
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Provider Business Mailing Address
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Address Line | 2394 NW 5TH ST
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City | MIAMI
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State | FL
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Zip | 33125-4416
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Country | US
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Telephone | 305-234-0009
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Fax | 305-234-8688
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. YESENIA MEDINA
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Credential | D.O.
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Telephone | 305-234-8688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS10520
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License Number State | FL
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