Provider Demographics
NPI:1114909645
Name:MEDINA DELGADO, ALMA N (MD)
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:N
Last Name:MEDINA DELGADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALMA
Other - Middle Name:N
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6163
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:1525 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-4105
Practice Address - Country:US
Practice Address - Phone:817-804-1100
Practice Address - Fax:817-299-8790
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1168208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E31497Medicare UPIN