Individual
CARLO MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4560 ADMIRALTY WAY STE 201, MARINA DEL REY, CA 90292-5425
(310) 823-3443
(310) 305-7470
Mailing address
1626 MONTANA AVE # 631, SANTA MONICA, CA 90403-1808
(310) 823-3443
(310) 305-7470
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C53912
CA
208M00000X
Hospitalist Physician
C53912
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902846306
GROUP NPI
CA
01
—
GR0100430
GROUP MEDICAL
CA
01
—
W18762
GROUP MEDICARE
CA
Enumeration date
02/01/2006
Last updated
05/01/2024
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