Provider Demographics
NPI:1558588699
Name:MEDINA, FLORENCIO A (RNFA)
Entity Type:Individual
Prefix:MR
First Name:FLORENCIO
Middle Name:A
Last Name:MEDINA
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNFA
Mailing Address - Street 1:32108 ALVARADO BLVD # 285
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4000
Mailing Address - Country:US
Mailing Address - Phone:408-834-3348
Mailing Address - Fax:
Practice Address - Street 1:32108 ALVARADO BLVD # 285
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-4000
Practice Address - Country:US
Practice Address - Phone:408-834-3348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA623513163WR0006X, 163WR0006X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR85671Medicare UPIN
CAH52548Medicare UPIN
CAR85671Medicare UPIN
CAH52548Medicare UPIN