Healthcare Provider Details

I. General information

NPI: 1487067419
Provider Name (Legal Business Name): TRISTAN MENZ DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 GREENHAVEN DR
SACRAMENTO CA
95831-5166
US

IV. Provider business mailing address

3723 KENWOOD WAY
ROSEVILLE CA
95747-9744
US

V. Phone/Fax

Practice location:
  • Phone: 916-231-4445
  • Fax:
Mailing address:
  • Phone: 916-412-5238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number19501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: