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General NPI Number Information
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NPI Number | 1700242617
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Entity Type | Organization
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Legal Business Name | CARLOS MEDINA MD PA
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Dates
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Enumeration Date | 01/07/2016
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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 | 1101 WATERSIDE LN
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City | HOLLYWOOD
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State | FL
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Zip | 33019-5005
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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 | OWNER
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Name | CARLOS MEDINA
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Credential | M.D.
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Telephone | 786-817-7808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | ME106831
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License Number State | FL
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