Healthcare Provider Details

I. General information

NPI: 1164995890
Provider Name (Legal Business Name): MR. FABIAN MENESES I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 N HIGHWAY 59 STE G-K
MERCED CA
95348-9404
US

IV. Provider business mailing address

3360 N HIGHWAY 59 STE G-K
MERCED CA
95348-9404
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-2125
  • Fax:
Mailing address:
  • Phone: 209-725-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: