Provider Demographics
NPI:1841421773
Name:MEDINA, FABIOLA (CSA)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3931
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-3931
Mailing Address - Country:US
Mailing Address - Phone:956-592-5022
Mailing Address - Fax:281-463-6835
Practice Address - Street 1:16151 CAIRNWAY DR STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3555
Practice Address - Country:US
Practice Address - Phone:956-592-5022
Practice Address - Fax:281-463-6835
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX06247363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical