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General NPI Number Information
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NPI Number | 1730869777
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Entity Type | Individual
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Provider Name | BEATRIZ MEDINA PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 1629 AVE. JUAN PONCE DE LEON, URB CARIBE, SUITE 2
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 939-308-4063
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 261869
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City | SAN JUAN
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State | PR
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Zip | 00926-2648
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Country | US
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Telephone | 939-308-4063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5691
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 5691
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5691
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License Number State | PR
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