Provider Demographics
NPI:1457243602
Name:MEDINA, MERCEDES
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 N LEAVITT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6224
Mailing Address - Country:US
Mailing Address - Phone:847-612-6980
Mailing Address - Fax:
Practice Address - Street 1:CIRCUITO DEL LINCE #366
Practice Address - Street 2:
Practice Address - City:ZAPOPAN
Practice Address - State:JALISCO
Practice Address - Zip Code:45237
Practice Address - Country:MX
Practice Address - Phone:847-612-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No376J00000XNursing Service Related ProvidersHomemaker