Healthcare Provider Details

I. General information

NPI: 1215696216
Provider Name (Legal Business Name): ANA LYDIA MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 W FLAMINGO RD STE 25A
LAS VEGAS NV
89103-3707
US

IV. Provider business mailing address

3822 WELCAMPO GRANDE AVE
NORTH LAS VEGAS NV
89031-3707
US

V. Phone/Fax

Practice location:
  • Phone: 702-871-9917
  • Fax:
Mailing address:
  • Phone: 336-343-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: