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Individual
DR. VIVIAN MEDINA
Active
Individual
DR. VIVIAN MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN-12750
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
073649000
—
FL
Enumeration date
07/26/2006
Last updated
12/05/2011
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