Provider Demographics
NPI:1578440426
Name:MEDINA, RUBEN (CHW)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:MEDINA
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:RUBEN
Other - Middle Name:A
Other - Last Name:RAMOS MEDINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 400845
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0845
Mailing Address - Country:US
Mailing Address - Phone:702-731-0909
Mailing Address - Fax:702-731-1020
Practice Address - Street 1:FIRSTMED HEALTH AND WELLNESS CENTER
Practice Address - Street 2:701 N PECOS ROAD, BUILDING M
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101
Practice Address - Country:US
Practice Address - Phone:702-731-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CHW-6168172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker