Healthcare Provider Details

I. General information

NPI: 1366581357
Provider Name (Legal Business Name): OTHON JOSE MENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 FOOTHILL RD
VENTURA CA
93003-1600
US

IV. Provider business mailing address

3100 FOOTHILL RD
VENTURA CA
93003-1600
US

V. Phone/Fax

Practice location:
  • Phone: 805-641-4400
  • Fax:
Mailing address:
  • Phone: 805-641-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberA86327
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number2006-0345
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: