MEDICARE: ANDREW SHOU MEDINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1033084025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW SHOU MEDINA

Provider Business Mailing Address
First Line	:	4890 SUNROAD CENTRUM LN APT 430
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2057
Country	:	US
Telephone Number	:	530-681-8162
Fax Number	:

Provider Business Practice Location Address
First Line	:	5506 CANDLELIGHT DR
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-7711
Country	:	US
Telephone Number	:	858-459-8861
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2025
Last Update Date	:	10/08/2025

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Directions to “ ANDREW SHOU MEDINA ” Practice Location

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