Provider Demographics
NPI:1548976269
Name:MEDINA-CAMACHO, DANIELA CRISTINA (MS)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:CRISTINA
Last Name:MEDINA-CAMACHO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 CALLE SAMA
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-3509
Mailing Address - Country:US
Mailing Address - Phone:787-243-0123
Mailing Address - Fax:
Practice Address - Street 1:887 CALLE SAMA
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-3509
Practice Address - Country:US
Practice Address - Phone:787-243-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR543996890OtherPASSPORT