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Individual

JESUS HUMBERTO MEDINA JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LAT

Contact information

Practice address
1050 CHICKEN RANCH RD, SAN ELIZARIO, TX 79849
(915) 872-3900
Mailing address
955 CELUM RD, CLINT, TX 79836-4903
(191) 547-8123

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT2930
TX

Other

Enumeration date
10/19/2023
Last updated
10/19/2023
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