Provider Demographics
NPI:1346989720
Name:MEDINA, JESUS MANNUEL (PA)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:MANNUEL
Last Name:MEDINA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 VICTORIA LN STE 2
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3227
Mailing Address - Country:US
Mailing Address - Phone:956-365-4400
Mailing Address - Fax:956-365-4111
Practice Address - Street 1:1810 HALE AVE STE 9
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7532
Practice Address - Country:US
Practice Address - Phone:956-412-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15522363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical