Healthcare Provider Details

I. General information

NPI: 1992633614
Provider Name (Legal Business Name): LILIA MONICA MEDINA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S TELSHOR BLVD STE B201
LAS CRUCES NM
88011-8212
US

IV. Provider business mailing address

6688 N CENTRAL EXPY STE 1300
DALLAS TX
75206-3950
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-9845
  • Fax: 575-449-3226
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number769418
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: