A Medina Professional Dental Corporation
Organization Active NPI Dentist · Chula Vista, CA
NPI 1114167186 · NPPES record last updated Aug 26, 2015
Key facts
- NPI
- 1114167186
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- 29371 (CA)
- Legal business name
- A MEDINA PROFESSIONAL DENTAL CORPORATION
- Practice address
- 309 Third Avenue
Chula Vista, CA 91910-3910 - Phone
- (619) 420-6030
- Fax
- (619) 420-9102
- NPI assigned
- Mar 3, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Alfred A Medina, D.D.S.
- Title
- President
- Phone
- (619) 420-6030
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | 29371 | CA | Yes |
Addresses
Primary practice location
309 Third Avenue
Chula Vista, CA 91910-3910
Mailing address
309 Third Avenue
Chula Vista, CA 91910-3910
Phone (619) 420-6030
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000475909 | Other | CA | UNITED CONCORDIA |
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- Hannah Abad
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.