NPIMap

Organization Active NPI

Vivian Medina DDS PA

  • Dentist
  • Tampa, FL
National Provider Identifier
1316295223
Registry record updated Aug 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN12750 Issued in FL
Legal business name
VIVIAN MEDINA DDS PA
Practice address
3630 Madaca LN
Tampa, FL 33618-2057
Phone
(813) 264-0286
Fax
(813) 960-4667
NPI assigned
Aug 27, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Vivian MedinaNPI 1376566521
Title
Owner
Phone
(813) 264-0286

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN12750 FL Primary

Addresses

Primary practice location

3630 Madaca LN
Tampa, FL 33618-2057

Mailing address

3630 Madaca LN
Tampa, FL 33618-2057
Phone (813) 264-0286

National Provider Directory

National Provider Directory
Tax ID family
Medinaponceponce Ddspa2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346025600000",
    "number": "1316295223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3630 MADACA LN",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336182057",
            "telephone_number": "813-264-0286",
            "fax_number": "813-960-4667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 MADACA LN",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336182057",
            "telephone_number": "813-264-0286",
            "fax_number": "813-960-4667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVIAN MEDINA DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-27",
        "last_updated": "2012-08-27",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-264-0286",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN12750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.