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General NPI Number Information
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NPI Number | 1548545809
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Entity Type | Organization
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Legal Business Name | ALAN MEDINA, MD PA
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 08/14/2021
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Provider Practice Location Address
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Address Line | 19 NEW WATER OAK DR
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City | PALM COAST
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State | FL
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Zip | 32137-6958
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Country | US
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Telephone | 917-856-6519
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Fax | 386-597-2948
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Provider Business Mailing Address
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Address Line | 19 NEW WATER OAK DR
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City | PALM COAST
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State | FL
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Zip | 32137-6958
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Country | US
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Telephone | 917-856-6519
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Fax | 386-597-2948
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALAN MEDINA
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Credential | MD
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Telephone | 917-856-6519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 170738
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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