MEDICARE: DANIELA MEDINA

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
1	106E00000X	Assistant Behavior Analyst	0-26-16910	FL

General Provider Information

NPI Number	:	1902664972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELA MEDINA

Provider Business Mailing Address
First Line	:	12397 SAN JOSE BLVD APT 1436
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-2824
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12397 SAN JOSE BLVD APT 1436
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-2824
Country	:	US
Telephone Number	:	305-780-2545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	02/18/2026

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Directions to “ DANIELA MEDINA ” Practice Location

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