Provider Demographics
NPI:1912712712
Name:MEDINA, ALEXANDRA MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:MEDINA
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 CALLE SALTILLO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4642
Mailing Address - Country:US
Mailing Address - Phone:787-239-6554
Mailing Address - Fax:
Practice Address - Street 1:1680 CALLE SALTILLO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4642
Practice Address - Country:US
Practice Address - Phone:787-239-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7977103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical