Healthcare Provider Details

I. General information

NPI: 1245847094
Provider Name (Legal Business Name): KEVIN A BUENAHORA MEDINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE HNOS RODRIGUEZ EMA
CAROLINA PR
00979-5801
US

IV. Provider business mailing address

1 CALLE HNOS RODRIGUEZ EMA APT 1002
CAROLINA PR
00979-5809
US

V. Phone/Fax

Practice location:
  • Phone: 787-604-3317
  • Fax:
Mailing address:
  • Phone: 787-604-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22022
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: