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NPI Code Detail

MEDICARE: MRS. LIZAIDA MEDINA CANDELARIA M.D.

MEDICARE: MRS. LIZAIDA MEDINA CANDELARIA 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
1208000000XPediatrics PhysicianME113172FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942465216
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LIZAIDA MEDINA CANDELARIA M.D.
Provider Business Mailing Address
First Line : 9211 DUPONT PL
Second Line :
City : WELLINGTON
State : FL
Zip : 33414-6477
Country : US
Telephone Number : 561-619-2460
Fax Number : 561-828-9311
Provider Business Practice Location Address
First Line : 9121 N MILITARY TRL STE 102
Second Line :
City : PALM BEACH GARDENS
State : FL
Zip : 33410-5985
Country : US
Telephone Number : 561-619-2460
Fax Number : 561-828-9311
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2008
Last Update Date : 02/11/2016

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