Healthcare Provider Details

I. General information

NPI: 1649639022
Provider Name (Legal Business Name): EDUARDO J MEDINA PARRILLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300C CALLE MANUEL DOMENECH
SAN JUAN PR
00918-3509
US

IV. Provider business mailing address

PO BOX 367501
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 352-709-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number19628
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number19628
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: