Healthcare Provider Details

I. General information

NPI: 1720074099
Provider Name (Legal Business Name): HARRY SAMUEL MENCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W JANSS RD # 310
THOUSAND OAKS CA
91360-1848
US

IV. Provider business mailing address

227 W JANSS RD # 310
THOUSAND OAKS CA
91360-1848
US

V. Phone/Fax

Practice location:
  • Phone: 805-496-2949
  • Fax: 805-496-1844
Mailing address:
  • Phone: 805-496-2949
  • Fax: 805-496-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA41745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: