Provider Demographics
NPI:1033084025
Name:MEDINA, ANDREW SHOU
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:SHOU
Last Name:MEDINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4890 SUNROAD CENTRUM LN APT 430
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2057
Mailing Address - Country:US
Mailing Address - Phone:530-681-8162
Mailing Address - Fax:
Practice Address - Street 1:5506 CANDLELIGHT DR
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7711
Practice Address - Country:US
Practice Address - Phone:858-459-8861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider