Healthcare Provider Details

I. General information

NPI: 1588568851
Provider Name (Legal Business Name): ALEXIS MEDINA AGUILAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7285 BLUESTONE DR
RENO NV
89511-1320
US

IV. Provider business mailing address

75 MCCABE DR UNIT 19122
RENO NV
89511-4145
US

V. Phone/Fax

Practice location:
  • Phone: 775-391-0363
  • Fax:
Mailing address:
  • Phone: 775-391-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: