Provider Demographics
NPI:1740004183
Name:MEDINA, FERNANDO ENRRIQUE
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:ENRRIQUE
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 1:949 N PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-2724
Mailing Address - Country:US
Mailing Address - Phone:559-508-6020
Mailing Address - Fax:
Practice Address - Street 1:949 N PARKWAY DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2724
Practice Address - Country:US
Practice Address - Phone:559-508-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker