Medinilla, Otto R

Medinilla, Otto R is an sole proprietor health care provider with primary practice located at 11300 Lindbergh Blvd Ste 115 , Fort Myers FL 33913-8827. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Medinilla, Otto R can be contacted via phone (239) 245-8600.

Contact Information

Primary practice address
11300 Lindbergh Blvd Ste 115 Fort Myers FL 33913-8827
Phone: (239) 245-8600
Fax: (239) 245-8660
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X C50000198 Delaware

Profile Details

NPI number 1649259540
LBN Legal business name Medinilla, Otto R
Credentials PAC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 10th, 2006
Last updated Dec 1st, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649259540 NPPES
Delaware MEDICAID 1000036903

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