NPI 1114167186 · live from the CMS NPI Registry
A Medina Professional Dental Corporation
Dentist in Chula Vista, CA. National Provider Identifier 1114167186, active.
NPI record
| NPI | 1114167186 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist 122300000X |
| Practice location | 309 Third Avenue, Chula Vista, CA 91910 |
| Practice phone | 619-420-6030 |
| Enumerated | March 3, 2009 |
| Last updated | August 26, 2015 |
| Authorized official | Alfred Medina, President |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist primary | 122300000X | 29371 (CA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.