MEDICARE: DAVID ROBERTO MEDINA PA

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	363AM0700X	Medical Physician Assistant	PA11987	TX

General Provider Information

NPI Number	:	1790273712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ROBERTO MEDINA PA

Provider Business Mailing Address
First Line	:	5460 PAREDES LINE RD
Second Line	:	STE 200
City	:	BROWNSVILLE
State	:	TX
Zip	:	78526-9741
Country	:	US
Telephone Number	:	956-554-0010
Fax Number	:	956-554-3288

Provider Business Practice Location Address
First Line	:	5460 PAREDES LINE RD STE 200
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78526-9741
Country	:	US
Telephone Number	:	956-554-0010
Fax Number	:	956-554-3288

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

Provider Enumeration Date	:	04/25/2018
Last Update Date	:	05/22/2025

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Directions to “ DAVID ROBERTO MEDINA PA” Practice Location

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