Healthcare Provider Details

I. General information

NPI: 1114909645
Provider Name (Legal Business Name): ALMA N MEDINA DELGADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALMA N MEDINA MD

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 S COOPER ST
ARLINGTON TX
76010-4105
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 817-804-1100
  • Fax: 817-299-8790
Mailing address:
  • Phone: 682-885-6163
  • Fax: 682-885-7347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ1168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: