Individual
GRACE M MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
AVE EL JIBARO CARR 172 KM 13.5, CIDRA, PR 00739
(787) 739-8182
Mailing address
PO BOX 1330, CIDRA, PR 00739-1330
(787) 739-8182
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
14864
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184026221
—
PR
Enumeration date
06/05/2019
Last updated
03/09/2020
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