Healthcare Provider Details

I. General information

NPI: 1376224386
Provider Name (Legal Business Name): STEVE MENCHACA RN, VA-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15830 SANTA CLARA CT
BAKERSFIELD CA
93314-4842
US

IV. Provider business mailing address

15830 SANTA CLARA CT
BAKERSFIELD CA
93314-4842
US

V. Phone/Fax

Practice location:
  • Phone: 661-932-5854
  • Fax:
Mailing address:
  • Phone: 661-932-5854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number776875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: