Healthcare Provider Details

I. General information

NPI: 1851339089
Provider Name (Legal Business Name): RAYMOND M MENCHACA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 W VENTURA ST
FILLMORE CA
93015-1837
US

IV. Provider business mailing address

2705 LOMA VISTA RD SUITE 205
VENTURA CA
93003-1581
US

V. Phone/Fax

Practice location:
  • Phone: 805-524-2672
  • Fax: 805-524-3953
Mailing address:
  • Phone: 805-667-2801
  • Fax: 805-667-2865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG75144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: