Healthcare Provider Details

I. General information

NPI: 1285089243
Provider Name (Legal Business Name): MENA MIRHOM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1659 OCEAN FRONT WALK
SANTA MONICA CA
90401-3154
US

IV. Provider business mailing address

1659 OCEAN FRONT WALK
SANTA MONICA CA
90401-3154
US

V. Phone/Fax

Practice location:
  • Phone: 917-402-0564
  • Fax:
Mailing address:
  • Phone: 917-402-0564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC207089
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA10430200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: