Individual
MARA LEE MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15 CALLE DOCTOR BASORA, MAYAGUEZ, PR 00681
(787) 834-0101
Mailing address
PO BOX 387, SAN ANTONIO, PR 00690-0387
(787) 975-2520
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
021964
PR
208D00000X
General Practice Physician
21964
PR
Other
Enumeration date
09/15/2020
Last updated
09/15/2020
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