Healthcare Provider Details

I. General information

NPI: 1649463225
Provider Name (Legal Business Name): HARRY S. MENCO, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

227 W JANSS RD SUITE 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 Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE MCCRACKEN
Title or Position: BILLING MANAGER
Credential:
Phone: 805-496-2949