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General NPI Number Information
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NPI Number | 1750285326
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Entity Type | Individual
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Provider Name | MATTHEW MEDINA
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Gender | Male
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 9425 SUNSET DR STE 164
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City | MIAMI
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State | FL
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Zip | 33173-3290
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Country | US
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Telephone | 305-279-2286
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Fax |
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Provider Business Mailing Address
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Address Line | 8215 SW 152ND AVE APT G-206
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City | MIAMI
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State | FL
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Zip | 33193-4014
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Country | US
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Telephone | 786-913-0064
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-26-2849383
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License Number State | FL
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