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General NPI Number Information
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NPI Number | 1215597695
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Entity Type | Individual
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Provider Name | ANDRE ALBERTO MEDINA
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Gender | Male
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 2501 SW 22ND ST
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City | CORAL GABLES
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State | FL
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Zip | 33145-3403
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Country | US
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Telephone | 305-858-2545
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Fax |
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Provider Business Mailing Address
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Address Line | 9365 SW 77TH AVE APT 1003
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City | MIAMI
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State | FL
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Zip | 33156-7938
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Country | US
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Telephone | 786-271-4672
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN24247
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License Number State | FL
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