MEDICARE: MR. FLORENCIO A MEDINA RNFA

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	163WR0006X	Registered Nurse First Assistant	623513	CA

General Provider Information

NPI Number	:	1558588699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FLORENCIO A MEDINA RNFA

Provider Business Mailing Address
First Line	:	32108 ALVARADO BLVD # 285
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4000
Country	:	US
Telephone Number	:	408-834-3348
Fax Number	:

Provider Business Practice Location Address
First Line	:	32108 ALVARADO BLVD # 285
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4000
Country	:	US
Telephone Number	:	408-834-3348
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	10/16/2019

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