| Doctor Name: | TEODORO MEDINA |
| NPI Number: | 1093852113 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 14489 |
| Business Practice Address: | Centro De Salud Conductual De Aguadilla Ave. Kennedy # 15 Aguadilla, PR - 00603 |
| Business Phone Number: | 7878402575 |
| Business Fax Number: | 7878408391 |
| Mailing Address: | Ponce School Of Medicine, P O Box 7004 PONCE |
| State: | PR |
| Postal Code: | 007327004 |
| Phone Number: | 7878402575 |
| Fax Number: | 7878408391 |
| NPI Enumeration Date: | 01/30/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 14489 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |