Provider Demographics
NPI:1053151464
Name:MEDINA GONZALEZ, MARIA ESTHER
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ESTHER
Last Name:MEDINA GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTRO ACOGIDA, CALLE 36 #400
Mailing Address - Street 2:PARCELA FALU
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-444-9480
Mailing Address - Fax:
Practice Address - Street 1:CENTRO ACOGIDA, CALLE 36 #400
Practice Address - Street 2:PARCELA FALU
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-444-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR93640163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse