Provider Demographics
NPI:1528308657
Name:MEDINA SOTO, NAYRIN Z
Entity type:Individual
Prefix:
First Name:NAYRIN
Middle Name:Z
Last Name:MEDINA SOTO
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:HC 01 BOX 5855
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-5855
Mailing Address - Country:US
Mailing Address - Phone:787-616-4314
Mailing Address - Fax:787-551-7316
Practice Address - Street 1:CARRETERA 404 KM 1.9
Practice Address - Street 2:BARRIO CRUZ
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-5855
Practice Address - Country:US
Practice Address - Phone:787-616-4314
Practice Address - Fax:787-551-7316
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist