Healthcare Provider Details

I. General information

NPI: 1720727225
Provider Name (Legal Business Name): JUAN ALARCON MEDINA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W PUTNAM AVE
PORTERVILLE CA
93257-3257
US

IV. Provider business mailing address

4646 BROCKTON AVE # 301A
RIVERSIDE CA
92506-0102
US

V. Phone/Fax

Practice location:
  • Phone: 559-781-3700
  • Fax:
Mailing address:
  • Phone: 951-682-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: