Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | C36368 | CA |
Y | 222Z00000X | Podiatrist | C36368 | CA |
NPI | 1003071184 |
---|---|
Provider Name | Fernando Medina |
First Address | Santa Fe Springs, CA 90670-5558 |
Second Address | Santa Fe Springs, CA 90670-5558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 28/07/2008 |