Provider Demographics
NPI:1396459533
Name:MEDINA ORTIZ, MILANE SOMARY (LND, MHSN, DE-PR)
Entity type:Individual
Prefix:
First Name:MILANE
Middle Name:SOMARY
Last Name:MEDINA ORTIZ
Suffix:
Gender:F
Credentials:LND, MHSN, DE-PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AN-33 CALLE #32
Mailing Address - Street 2:URB. VILLAS DE RIO GRANDE
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-2836
Mailing Address - Country:US
Mailing Address - Phone:787-435-4392
Mailing Address - Fax:
Practice Address - Street 1:CARR. 857 KM 0.4
Practice Address - Street 2:BO. CANOVANILLAS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-435-4392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1267133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist