Healthcare Provider Details

I. General information

NPI: 1528025202
Provider Name (Legal Business Name): RICHARD MENENDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S CENTRAL AVE SUITE 350
GLENDALE CA
91204-2500
US

IV. Provider business mailing address

1510 S CENTRAL AVE SUITE 350
GLENDALE CA
91204-2500
US

V. Phone/Fax

Practice location:
  • Phone: 818-552-2100
  • Fax: 818-552-2101
Mailing address:
  • Phone: 818-552-2100
  • Fax: 818-552-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA76738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: