MEDICARE: DR. CARLOS ANGEL MEDINA PADILLA M.D.

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	208D00000X	General Practice Physician	14531	PR
2	208D00000X	General Practice Physician	ACN882	FL

General Provider Information

NPI Number	:	1417990763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS ANGEL MEDINA PADILLA M.D.

Provider Business Mailing Address
First Line	:	121 S ORANGE AVE STE 940
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3234
Country	:	US
Telephone Number	:	407-658-9687
Fax Number	:	407-658-9688

Provider Business Practice Location Address
First Line	:	5840 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-7558
Country	:	US
Telephone Number	:	407-720-7302
Fax Number	:	407-293-1355

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	12/28/2016

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