Healthcare Provider Details

I. General information

NPI: 1467155143
Provider Name (Legal Business Name): SANGEETA MENON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16405 SAND CANYON AVE STE 280
IRVINE CA
92618-3792
US

IV. Provider business mailing address

16405 SAND CANYON AVE STE 280
IRVINE CA
92618-3792
US

V. Phone/Fax

Practice location:
  • Phone: 949-557-0251
  • Fax: 949-557-0311
Mailing address:
  • Phone: 949-557-0251
  • Fax: 949-557-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95024169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: