Individual
AMALIA JESSICA MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1800 SW 22ND AVE APT 5, MIAMI, FL 33145-2140
(786) 803-3506
Mailing address
1800 SW 22ND AVE APT 5, MIAMI, FL 33145-2140
(786) 803-3506
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
18-59465
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023232800
—
FL
Enumeration date
03/25/2019
Last updated
03/25/2019
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