Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | ME60360 | FL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | ME60360 | FL |
NPI | 1639193923 |
---|---|
Provider Name | Dr. Carlos A Medina |
First Address | Miami, FL 33101-6960 |
Second Address | Miami, FL 33101-6960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 29/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23227 | (02) | FL |
3732894-00 | (05) | FL |
F64709 | (02) | FL |