Provider Demographics
NPI:1033939707
Name:MEDINA LOPEZ, SAHIRA M (MSW)
Entity type:Individual
Prefix:
First Name:SAHIRA
Middle Name:M
Last Name:MEDINA LOPEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9809
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9809
Mailing Address - Country:US
Mailing Address - Phone:787-704-0705
Mailing Address - Fax:787-744-4444
Practice Address - Street 1:431 AVE HOSTOS SAN JUAN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3014
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:787-744-4444
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR162591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical