Provider Demographics
NPI:1912447764
Name:MEDINA MONTANO, CLARIBEL
Entity type:Individual
Prefix:
First Name:CLARIBEL
Middle Name:
Last Name:MEDINA MONTANO
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 1:165 CALLE LA PAZ
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-3206
Mailing Address - Country:US
Mailing Address - Phone:787-868-3700
Mailing Address - Fax:
Practice Address - Street 1:165 CALLE LA PAZ
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3206
Practice Address - Country:US
Practice Address - Phone:787-868-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PR6510103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health