Provider Demographics
NPI:1902097819
Name:MEDINA, JULIO C SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:C
Last Name:MEDINA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:I30 CALLE 3
Mailing Address - Street 2:TINTILLO GARDENS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1635
Mailing Address - Country:US
Mailing Address - Phone:787-782-1185
Mailing Address - Fax:
Practice Address - Street 1:I30 CALLE 3
Practice Address - Street 2:TINTILLO GARDENS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1635
Practice Address - Country:US
Practice Address - Phone:787-782-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6990207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services