Healthcare Provider Details

I. General information

NPI: 1720945884
Provider Name (Legal Business Name): EDGAR MENENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E MARKET ST
LONG BEACH CA
90805-5910
US

IV. Provider business mailing address

260 E MARKET ST
LONG BEACH CA
90805-5910
US

V. Phone/Fax

Practice location:
  • Phone: 714-483-1241
  • Fax:
Mailing address:
  • Phone: 714-483-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number52869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: