Healthcare Provider Details

I. General information

NPI: 1346170107
Provider Name (Legal Business Name): DAVID MENCHACA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 E 17TH ST
SANTA ANA CA
92705-8629
US

IV. Provider business mailing address

1833 E 17TH ST
SANTA ANA CA
92705-8629
US

V. Phone/Fax

Practice location:
  • Phone: 714-941-8009
  • Fax:
Mailing address:
  • Phone: 714-941-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1480450922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: