Healthcare Provider Details

I. General information

NPI: 1730847187
Provider Name (Legal Business Name): CARLOS XAVIER MEDINA-PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR 190, AV. ROBERTO SANCHEZ VILELLA
CAROLINA PR
00979
US

IV. Provider business mailing address

PR 190 AV. ROBERTO SANCHEZ VILELLA
CAROLINA PR
00979
US

V. Phone/Fax

Practice location:
  • Phone: 787-762-1290
  • Fax:
Mailing address:
  • Phone: 787-762-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8569
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: