Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 103TC1900X | Counseling Psychologist |
NPI | 1073888988 |
---|---|
Provider Name | Dr. Angela J Medina-Lago |
First Address | Orlando, FL 32807-6166 |
Second Address | Orlando, FL 32807-6166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2012 |
Last Update Date | 12/03/2012 |