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NPI Code Detail

MEDICARE: EDWIN JOSE MEDINA

MEDICARE: EDWIN JOSE MEDINA
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1154055721
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWIN JOSE MEDINA
Provider Business Mailing Address
First Line : PO BOX 2129
Second Line :
City : SAN JUAN
State : PR
Zip : 00922-2129
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : UNIVERSITY OF PUERTO RICO MEDICAL SCIENCES CAMPUS
Second Line :
City : SAN JUAN
State : PR
Zip : 00926-5067
Country : US
Telephone Number : 787-758-2525
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2022
Last Update Date : 03/29/2026

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