Provider Demographics
NPI:1093867368
Name:MEDINA, ALEJANDRO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:A
Last Name:MEDINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:ME32 PLAZA 17
Mailing Address - Street 2:MONTE CLARO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-4792
Mailing Address - Country:US
Mailing Address - Phone:787-780-5930
Mailing Address - Fax:787-780-5930
Practice Address - Street 1:CALLE ISABEL II, EDIFICIO JOAQUIN MONTESINO
Practice Address - Street 2:OFICINA 103 B
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-780-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11421207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG-02984Medicare UPIN