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General NPI Number Information
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NPI Number | 1508684085
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Entity Type | Individual
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Provider Name | JULIA EMMA MEDINA PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 5 GRACE CHURCH ST
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City | PORT CHESTER
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State | NY
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Zip | 10573-4911
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Country | US
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Telephone | 914-632-2737
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 552
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City | RIVERSIDE
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State | CT
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Zip | 06878-0552
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6849
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License Number State | CT
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