Healthcare Provider Details

I. General information

NPI: 1477546414
Provider Name (Legal Business Name): MENARD BARRUGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

3006 S MARYLAND PKWY 505
LAS VEGAS NV
89109-2218
US

V. Phone/Fax

Practice location:
  • Phone: 888-350-2911
  • Fax: 702-369-5827
Mailing address:
  • Phone: 702-697-0082
  • Fax: 702-369-5827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG66243
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberG66243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: