Provider Demographics
NPI:1053519306
Name:MEDINA - DORTA, ZULEIKA (OT)
Entity type:Individual
Prefix:MISS
First Name:ZULEIKA
Middle Name:
Last Name:MEDINA - DORTA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 43019
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9484
Mailing Address - Country:US
Mailing Address - Phone:787-388-9679
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 43019
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-9484
Practice Address - Country:US
Practice Address - Phone:787-388-9679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PROTL 938174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist