MEDICARE: MS. ANA MEDINA CSFA

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	246ZC0007X	Surgical Assistant		NM

General Provider Information

NPI Number	:	1124761440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANA MEDINA CSFA

Provider Business Mailing Address
First Line	:	6604 VISTA HERMOSA
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-4957
Country	:	US
Telephone Number	:	575-649-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	6604 VISTA HERMOSA
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-4957
Country	:	US
Telephone Number	:	575-649-1131
Fax Number	:

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

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	04/14/2022

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