Provider Demographics
NPI:1790273712
Name:MEDINA, DAVID ROBERTO (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERTO
Last Name:MEDINA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5460 PAREDES LINE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-9741
Mailing Address - Country:US
Mailing Address - Phone:956-554-0010
Mailing Address - Fax:956-554-3288
Practice Address - Street 1:3302 BOCA CHICA BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-5193
Practice Address - Country:US
Practice Address - Phone:956-982-1001
Practice Address - Fax:956-550-9393
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA11987363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical