Healthcare Provider Details

I. General information

NPI: 1619121324
Provider Name (Legal Business Name): JOSE MANUEL MEDINA SANCHEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 PROVIDENCE RD
BRANDON FL
33511-4885
US

IV. Provider business mailing address

PO BOX 947387
ORLANDO FL
32886-5387
US

V. Phone/Fax

Practice location:
  • Phone: 813-542-5274
  • Fax: 813-643-1155
Mailing address:
  • Phone: 813-549-2134
  • Fax: 813-864-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME107516
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number017019
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: