Healthcare Provider Details

I. General information

NPI: 1053859678
Provider Name (Legal Business Name): MENA SAID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR # MC8895
SAN DIEGO CA
92103
US

IV. Provider business mailing address

200 W ARBOR DR # MC8895
SAN DIEGO CA
92103-1911
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-1967
  • Fax: 619-543-5521
Mailing address:
  • Phone: 619-543-1967
  • Fax: 619-543-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA180607
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: