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NPI Code Detail

MEDICARE: MRS. NIDIA E MEDINA RUIZ PHD

MEDICARE: MRS. NIDIA E MEDINA RUIZ PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMH15715FL

General Provider Information

NPI Number : 1578767505
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NIDIA E MEDINA RUIZ PHD
Provider Business Mailing Address
First Line : 1707 ORLANDO CENTRAL PKWY STE 480
Second Line :
City : ORLANDO
State : FL
Zip : 32809-5785
Country : US
Telephone Number : 321-337-8225
Fax Number :
Provider Business Practice Location Address
First Line : 1707 ORLANDO CENTRAL PKWY STE 480
Second Line :
City : ORLANDO
State : FL
Zip : 32809-5785
Country : US
Telephone Number : 321-337-8225
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2007
Last Update Date : 09/13/2023

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