MEDICARE: DR. JULIO C. MEDINA SR. M.D.

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	6990	PR

General Provider Information

NPI Number	:	1902097819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIO C. MEDINA SR. M.D.

Provider Business Mailing Address
First Line	:	I30 CALLE 3
Second Line	:	TINTILLO GARDENS
City	:	GUAYNABO
State	:	PR
Zip	:	00966-1635
Country	:	US
Telephone Number	:	787-782-1185
Fax Number	:

Provider Business Practice Location Address
First Line	:	I30 CALLE 3
Second Line	:	TINTILLO GARDENS
City	:	GUAYNABO
State	:	PR
Zip	:	00966-1635
Country	:	US
Telephone Number	:	787-782-1185
Fax Number	:

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

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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