Provider Demographics
NPI:1548996804
Name:MEDINA MONTALVO, NISHKA MARIE (DC)
Entity type:Individual
Prefix:
First Name:NISHKA
Middle Name:MARIE
Last Name:MEDINA MONTALVO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 16450
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9663
Mailing Address - Country:US
Mailing Address - Phone:787-240-1980
Mailing Address - Fax:
Practice Address - Street 1:PLAZA CONSTANCIA
Practice Address - Street 2:SUITE 104
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-0097
Practice Address - Country:US
Practice Address - Phone:787-602-9522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000874111N00000X
FL14169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor