Provider Demographics
NPI:1699005991
Name:DAISY MEDINA HERNANDEZ
Entity type:Organization
Organization Name:DAISY MEDINA HERNANDEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-210-2463
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0494
Mailing Address - Country:US
Mailing Address - Phone:787-210-2463
Mailing Address - Fax:
Practice Address - Street 1:CARR 113 KM 11.8 INT
Practice Address - Street 2:700 CALLE SUSANO LA SALLE
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-2475
Practice Address - Country:US
Practice Address - Phone:787-210-2463
Practice Address - Fax:787-395-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 6313416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport