Provider Demographics
NPI:1477791192
Name:MEDINA, MARTHA CARMEN (PA - C)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:CARMEN
Last Name:MEDINA
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2708
Mailing Address - Country:US
Mailing Address - Phone:956-631-5411
Mailing Address - Fax:956-631-7129
Practice Address - Street 1:5201 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2708
Practice Address - Country:US
Practice Address - Phone:956-631-5411
Practice Address - Fax:956-631-7129
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 05420363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant