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General NPI Number Information
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NPI Number | 1457824641
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Entity Type | Individual
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Provider Name | SONIA MEDINA
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Gender | Female
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 17924 SABAL PALM DR STE 3
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City | PENITAS
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State | TX
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Zip | 78576-0977
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Country | US
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Telephone | 956-581-8060
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Fax |
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Provider Business Mailing Address
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Address Line | 621 N ALAMO RD
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City | EDINBURG
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State | TX
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Zip | 78542-2552
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Country | US
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Telephone | 956-292-4006
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 215410
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License Number State | TX
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