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General NPI Number Information
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NPI Number | 1417798158
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Entity Type | Individual
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Provider Name | FABIOLA MEDINA
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Gender | Female
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | UTMB GME C/O E ESPINO 301 UNIVERSITY BLVD 5.138 RS
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City | GALVESTON
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State | TX
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Zip | 77555-0001
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Country | US
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Telephone | 713-397-3436
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Fax |
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Provider Business Mailing Address
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Address Line | 6502 MCMAHAN DR
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City | LEAGUE CITY
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State | TX
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Zip | 77573
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Country | US
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Telephone | 713-397-3436
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | BP10089980
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License Number State | TX
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