Healthcare Provider Details

I. General information

NPI: 1225741663
Provider Name (Legal Business Name): MENM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 EL CAMINO REAL STE A
SAN BRUNO CA
94066-1300
US

IV. Provider business mailing address

8300 CENTRAL PARK DR STE 100
WACO TX
76712-6666
US

V. Phone/Fax

Practice location:
  • Phone: 650-588-8222
  • Fax:
Mailing address:
  • Phone: 650-588-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: NIDIA GARCIA
Title or Position: ME FLAGSHIP
Credential:
Phone: 254-227-6825