Provider Demographics
NPI:1609437946
Name:MEDINA, RUBEN ANDY (PA)
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:ANDY
Last Name:MEDINA
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Gender:M
Credentials:PA
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Mailing Address - Street 1:5130 GATEWAY BLVD E # 51015
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-1608
Mailing Address - Country:US
Mailing Address - Phone:915-215-4480
Mailing Address - Fax:915-215-5386
Practice Address - Street 1:4801 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2707
Practice Address - Country:US
Practice Address - Phone:915-215-5300
Practice Address - Fax:915-215-8606
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2023-11-08
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Provider Licenses
StateLicense IDTaxonomies
TXPA13263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant