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NPI Code Detail

MEDICARE: JAQUILINE MEDINA MA

MEDICARE: JAQUILINE MEDINA MA
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
1101YM0800XMental Health CounselorCOUI9732ID

General Provider Information

NPI Number : 1992534523
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAQUILINE MEDINA MA
Provider Business Mailing Address
First Line : 1910 PACIFIC AVE STE 2000
Second Line :
City : DALLAS
State : TX
Zip : 75201-4540
Country : US
Telephone Number : 215-774-3527
Fax Number :
Provider Business Practice Location Address
First Line : 1910 PACIFIC AVE SUITE 2000
Second Line : #1957
City : DALLAS
State : TX
Zip : 75201
Country : US
Telephone Number : 215-774-3527
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2024
Last Update Date : 05/30/2026

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Directions to “ JAQUILINE MEDINA MA” Practice Location

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