Healthcare Provider Details

I. General information

NPI: 1437202736
Provider Name (Legal Business Name): MENKA RUGHANI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SHOPS AT MISSION VIEJO STE 30 SHOPS AT MISSION VIEJO
MISSINO VIEJO CA
92691
US

IV. Provider business mailing address

10586 MOUNTAIN VIEW AVE APT A
REDLANDS CA
92373-8420
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-4010
  • Fax: 949-364-4001
Mailing address:
  • Phone: 714-342-1507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13161T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: