Healthcare Provider Details

I. General information

NPI: 1477573111
Provider Name (Legal Business Name): DENISE MENCHACA M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 JENSEN CT SUITE 2C
THOUSAND OAKS CA
91360-7483
US

IV. Provider business mailing address

1220 LA VENTA DR SUITE 102
WESTLAKE VILLAGE CA
91361-3703
US

V. Phone/Fax

Practice location:
  • Phone: 805-413-1070
  • Fax: 805-413-1076
Mailing address:
  • Phone: 805-777-7370
  • Fax: 805-777-7380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: