Provider Demographics
NPI:1043462211
Name:MEDINA, YESENIA (DO)
Entity type:Individual
Prefix:DR
First Name:YESENIA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850001, DEPT 8340
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0001
Mailing Address - Country:US
Mailing Address - Phone:813-536-7277
Mailing Address - Fax:855-830-1722
Practice Address - Street 1:971 VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1944
Practice Address - Country:US
Practice Address - Phone:561-688-5030
Practice Address - Fax:561-688-9565
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-19
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine