MEDICARE: LEANN 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	311ZA0620X	Adult Care Home Facility		TX

General Provider Information

NPI Number	:	1528924248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANN MEDINA

Provider Business Mailing Address
First Line	:	4207 WILLIAMS RD
Second Line	:
City	:	WEST POINT
State	:	TX
Zip	:	78963-2219
Country	:	US
Telephone Number	:	361-772-5880
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 WILLIAMS RD
Second Line	:
City	:	WEST POINT
State	:	TX
Zip	:	78963-2219
Country	:	US
Telephone Number	:	361-772-5880
Fax Number	:

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

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	12/26/2025

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Directions to “ LEANN MEDINA ” Practice Location

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