Provider Demographics
NPI:1992472500
Name:MEDINA CHINAS, YANET ALICIA (PA)
Entity type:Individual
Prefix:
First Name:YANET ALICIA
Middle Name:
Last Name:MEDINA CHINAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 ROWLETT RD APT 515
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-3703
Mailing Address - Country:US
Mailing Address - Phone:907-885-8414
Mailing Address - Fax:
Practice Address - Street 1:450 LINCOLN AVE STE 101
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2652
Practice Address - Country:US
Practice Address - Phone:831-269-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14695363A00000X
CAPA63784363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant