Active NPI
Mateo Andres Medina Cordoba, SA-C
- Surgical Assistant
- Miami, FL
National Provider Identifier
1194582536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 24-182
- Practice address
- 13960 SW 160TH Ave
Miami, FL 33196-6453 - Phone
- (561) 690-8086
- NPI assigned
- Mar 4, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 24-182 | FL | Primary |
Addresses
Primary practice location
13960 SW 160TH Ave
Miami, FL 33196-6453
Mailing address
13960 SW 160TH Ave
Miami, FL 33196-6453
Phone (561) 690-8086
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24-182 | FL | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709510400000",
"number": "1194582536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13960 SW 160TH AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331966453",
"telephone_number": "561-690-8086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13960 SW 160TH AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331966453",
"telephone_number": "561-690-8086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA CORDOBA",
"first_name": "MATEO",
"middle_name": "ANDRES",
"credential": "SA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-04",
"last_updated": "2024-03-04",
"certification_date": "2024-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "FL",
"license": "24-182",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.