MEDICARE: RONY E MEDINA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	15130	CA

General Provider Information

NPI Number	:	1013058627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONY E MEDINA PA-C

Provider Business Mailing Address
First Line	:	15715 GUNDRY AVE
Second Line	:
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-3938
Country	:	US
Telephone Number	:	562-895-4223
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 N VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1701
Country	:	US
Telephone Number	:	323-665-4230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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Directions to “ RONY E MEDINA PA-C” Practice Location

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