Basic Information
Provider Information
NPI: 1306838867
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEDINA
FirstName: RHONDA
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1001 BELLEFONTAINE AVE
Address2:  
City: LIMA
State: OH
PostalCode: 458042800
CountryCode: US
TelephoneNumber: 4199984575
FaxNumber: 4199984586
Practice Location
Address1: 1220 E ELM ST STE 101
Address2:  
City: LIMA
State: OH
PostalCode: 458042803
CountryCode: US
TelephoneNumber: 4199988245
FaxNumber: 4199988247
Other Information
ProviderEnumerationDate: 08/19/2005
LastUpdateDate: 01/04/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X35.077824OHY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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