Provider Demographics
NPI:1346989720
Name:MEDINA, JESUS MANNUEL (PA)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:MANNUEL
Last Name:MEDINA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 E RIDGE RD STE F
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1525
Mailing Address - Country:US
Mailing Address - Phone:956-631-8875
Mailing Address - Fax:956-683-1502
Practice Address - Street 1:1309 E RIDGE RD STE 1
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1518
Practice Address - Country:US
Practice Address - Phone:956-631-8875
Practice Address - Fax:956-683-1502
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA15522363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical