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General NPI Number Information
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NPI Number | 1487895124
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Entity Type | Individual
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Provider Name | CARLOS REYDELL MEDINA MD
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Gender | Male
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 21110 BISCAYNE BLVD STE 201
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City | AVENTURA
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State | FL
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Zip | 33180-1251
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Country | US
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Telephone | 786-817-7808
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Fax | 786-551-2299
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Provider Business Mailing Address
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Address Line | 1835 E HALLANDALE BEACH BLVD # 134
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4619
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Country | US
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Telephone | 786-817-7808
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Fax | 786-551-2299
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 182714
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME106831
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License Number State | FL
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