Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 11421 | PR |
NPI | 1093867368 |
---|---|
Provider Name | Dr. Alejandro A. Medina |
First Address | Bayamon, PR 00961-4792 |
Second Address | Bayamon, PR 00961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G-02984 | (02) | PR |