Provider Demographics
NPI:1447051800
Name:MEDINA COLINA, MELISSA DEL MAR
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DEL MAR
Last Name:MEDINA COLINA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 CONSULATE DR STE 11
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8806
Mailing Address - Country:US
Mailing Address - Phone:321-444-9527
Mailing Address - Fax:407-641-9591
Practice Address - Street 1:2151 CONSULATE DR STE 11
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8806
Practice Address - Country:US
Practice Address - Phone:321-444-9527
Practice Address - Fax:407-641-9591
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty