Provider Demographics
NPI:1538855366
Name:MEDINA, JESSE NOEL (MD)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:NOEL
Last Name:MEDINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 NW 12 AVENUE, CENTRAL 600-D
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-585-5215
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12 AVENUE, CENTRAL 600-D
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-585-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-11-28
Deactivation Date:2023-11-17
Deactivation Code:
Reactivation Date:2023-11-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program