Individual
DR. CHARLES ISREAL MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, FNP-C, ENP-C
Contact information
Practice address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
(214) 759-3593
Mailing address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
(214) 857-1860
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP132602
TX
363LF0000X
Family Nurse Practitioner
17346
CA
363LF0000X
Family Nurse Practitioner
A150308
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255539821
—
CA
Enumeration date
07/05/2007
Last updated
05/10/2018
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