Healthcare Provider Details

I. General information

NPI: 1366456246
Provider Name (Legal Business Name): WILLIAM RAYMOND MENZIES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18785 S. BROOKHURST STREET SUITE 200
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

PO BOX 3699
NEWPORT BEACH CA
92659-8699
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-5330
  • Fax: 714-378-5320
Mailing address:
  • Phone: 657-241-3600
  • Fax: 657-241-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG28504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: