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General NPI Number Information
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NPI Number | 1639319312
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Entity Type | Organization
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Legal Business Name | NORBERTO MEDINA PELLICER
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | AVE LAGUNA SUITE 200
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City | CAROLINA
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State | PR
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Zip | 00979-6434
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Country | US
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Telephone | 787-791-0906
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Fax | 787-791-6117
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Provider Business Mailing Address
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Address Line | LAGUNA GARDENS SHOPPING CENTER SUITE 200
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City | CAROLINA
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State | PR
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Zip | 00979
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Country | US
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Telephone | 787-791-0906
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Fax | 787-791-6117
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Authorized Official
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Title or Position | DUENO
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Name | DR. NORBERTO MEDINA
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Credential | DMD
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Telephone | 787-791-0906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1302
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License Number State | PR
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