MEDICARE: DR. CELERINA DE BORJA MEDINA

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	208D00000X	General Practice Physician	A45547	CA

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	:	1356399919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CELERINA DE BORJA MEDINA

Provider Business Mailing Address
First Line	:	4149 TWEEDY BOULEVARD
Second Line	:	STE B
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-6167
Country	:	US
Telephone Number	:	323-564-4545
Fax Number	:	323-564-3063

Provider Business Practice Location Address
First Line	:	4149 TWEEDY BOULEVARD
Second Line	:	STE B
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-6167
Country	:	US
Telephone Number	:	323-564-4545
Fax Number	:	323-564-3063

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	06/29/2012

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