MEDICARE: VALERIE JOANNA MEDINA NP

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	363LF0000X	Family Nurse Practitioner	1201800	TX

General Provider Information

NPI Number	:	1790679421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE JOANNA MEDINA NP

Provider Business Mailing Address
First Line	:	794 OVINGTON RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79928-5739
Country	:	US
Telephone Number	:	915-540-4251
Fax Number	:

Provider Business Practice Location Address
First Line	:	6974 GATEWAY BLVD E STE F
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79915-1115
Country	:	US
Telephone Number	:	915-540-4251
Fax Number	:

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

Provider Enumeration Date	:	06/06/2025
Last Update Date	:	06/06/2025

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