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General NPI Number Information
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NPI Number | 1427207075
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Entity Type | Organization
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Legal Business Name | NILDA G. MEDINA
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | CASTELLANA GARDENS CAMPO RICO AVE. R5 NUMBER 7
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City | CAROLINA
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State | PR
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Zip | 00983
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Country | US
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Telephone | 787-762-4555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1773
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City | CAROLINA
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State | PR
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Zip | 00984-1773
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Country | US
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Telephone | 787-762-4555
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Fax |
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Authorized Official
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Title or Position | OWNER PSYCHOLOGIST
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Name | DR. NILDA G. MEDINA
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Credential | PH.D.
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Telephone | 787-762-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1963
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License Number State | PR
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