Provider Demographics
NPI:1942095765
Name:MEDINA, JOSE MANUEL JR (RN)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MANUEL
Last Name:MEDINA
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N CENTRAL AVE STE 2500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2505
Mailing Address - Country:US
Mailing Address - Phone:602-427-2370
Mailing Address - Fax:
Practice Address - Street 1:915 E PALM LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2116
Practice Address - Country:US
Practice Address - Phone:602-257-3853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ271986163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health