MEDICARE: MR. ANDRES MEDINA-VECCHINI

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	207P00000X	Emergency Medicine Physician	36122	PR
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207P00000X	Emergency Medicine Physician	D0104177	MD

General Provider Information

NPI Number	:	1952871089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDRES MEDINA-VECCHINI

Provider Business Mailing Address
First Line	:	201 CALLE QUENEPA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5129
Country	:	US
Telephone Number	:	787-399-8208
Fax Number	:

Provider Business Practice Location Address
First Line	:	388 ZONA IND REPARADA 2
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716-2347
Country	:	US
Telephone Number	:	787-840-2575
Fax Number	:

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

Provider Enumeration Date	:	12/02/2018
Last Update Date	:	03/05/2026

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