MEDICARE: DR. ALICIA MEDRANO ONG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME78831	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174536767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA MEDRANO ONG MD

Provider Business Mailing Address
First Line	:	1037 PROFESSIONAL PARK DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-4886
Country	:	US
Telephone Number	:	813-684-5659
Fax Number	:	813-685-2640

Provider Business Practice Location Address
First Line	:	1037 PROFESSIONAL PARK DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-4886
Country	:	US
Telephone Number	:	813-684-5659
Fax Number	:	813-685-2640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	12/02/2008

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