Provider Demographics
NPI:1871361105
Name:MEDINA HEALTHCARE LLC
Entity type:Organization
Organization Name:MEDINA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:YURITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP & PMHNP- BC
Authorized Official - Phone:786-278-8785
Mailing Address - Street 1:480 SE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5749
Mailing Address - Country:US
Mailing Address - Phone:786-398-1326
Mailing Address - Fax:786-590-1033
Practice Address - Street 1:766 E 10TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3636
Practice Address - Country:US
Practice Address - Phone:786-398-1326
Practice Address - Fax:786-590-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty