Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2063081 | TX |
NPI | 1043790140 |
---|---|
Provider Name | Miroslava M Medellin |
First Address | Corpus Christi, TX 78412-3123 |
Second Address | Corpus Christi, TX 78404-3834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |