MEDICARE: DR. MARELYN MEDINA & ASSOCIATES 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	174400000X	Specialist	J9759	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00940U	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1881870723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MARELYN MEDINA & ASSOCIATES PA

Provider Business Mailing Address
First Line	:	412 E DOVE AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2240
Country	:	US
Telephone Number	:	956-686-7243
Fax Number	:	956-668-7123

Provider Business Practice Location Address
First Line	:	412 E DOVE AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2240
Country	:	US
Telephone Number	:	956-686-7243
Fax Number	:	956-668-7123

Authorized Official
Title or Position	:	MANAGER
Name	:	MARELYN MEDINA
Credential	:	MD
Telephone Number	:	956-686-7243

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	10/02/2018

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