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NPI Code Detail

MEDICARE: MR. ROBERT M MEDINA P.A.

MEDICARE: MR. ROBERT M MEDINA P.A.
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
1363A00000XPhysician AssistantPA10207CA

General Provider Information

NPI Number : 1235185190
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT M MEDINA P.A.
Provider Business Mailing Address
First Line : 390 NORTH LOOP ROAD
Second Line :
City : FORT IRWIN
State : CA
Zip : 92310-5109
Country : US
Telephone Number : 760-383-5289
Fax Number : 760-383-5128
Provider Business Practice Location Address
First Line : 390 NORTH LOOP ROAD
Second Line :
City : FORT IRWIN
State : CA
Zip : 92310-5109
Country : US
Telephone Number : 760-383-5289
Fax Number : 760-383-5128
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 01/26/2024

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