Provider Demographics
NPI:1396459533
Name:MEDINA ORTIZ, MILANE SOMARY
Entity type:Individual
Prefix:
First Name:MILANE
Middle Name:SOMARY
Last Name:MEDINA ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1682 CALLE PARANA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3144
Mailing Address - Country:US
Mailing Address - Phone:787-435-4392
Mailing Address - Fax:
Practice Address - Street 1:1682 CALLE PARANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3144
Practice Address - Country:US
Practice Address - Phone:787-435-4392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1267133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist