| Carlo Medina Medical Corporation | |
|
4560 Admiralty Way Ste 201 Marina Del Rey CA 90292-5425 | |
| (310) 823-3443 | |
| (310) 305-7470 |
| Full Name | Carlo Medina Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 4560 Admiralty Way Ste 201, Marina Del Rey, California |
| Authorized Official Name and Position | Carlo Medina (PRESIDENT) |
| Authorized Official Contact | 9173126385 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carlo Medina Medical Corporation 1626 Montana Ave # 631 Santa Monica CA 90403-1808 Ph: (310) 893-0827 | Carlo Medina Medical Corporation 4560 Admiralty Way Ste 201 Marina Del Rey CA 90292-5425 Ph: (310) 823-3443 |
| NPI Number | 1477273340 |
|---|---|
| Provider Enumeration Date | 08/31/2022 |
| Last Update Date | 06/18/2024 |
| Medicare PECOS PAC ID | 5890171664 |
|---|---|
| Medicare Enrollment ID | O20220930002246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477273340 | NPI | - | NPPES |
| H76953 | Other | CA | UPON |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Carlo Medina |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1093786444 PECOS PAC ID: 6901818087 Enrollment ID: I20100630000706 |
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