MEDICARE: CHRISTOPHER MEDINA LVN

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	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1568887735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER MEDINA LVN

Provider Business Mailing Address
First Line	:	6236 QUAIL AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-4307
Country	:	US
Telephone Number	:	915-204-8267
Fax Number	:

Provider Business Practice Location Address
First Line	:	6236 QUAIL AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-4307
Country	:	US
Telephone Number	:	915-204-8267
Fax Number	:

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

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	02/25/2014

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Directions to “ CHRISTOPHER MEDINA LVN” Practice Location

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