Healthcare Provider Details

I. General information

NPI: 1346362993
Provider Name (Legal Business Name): MICHAEL MENARD R. NCS. T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14482 BEACH BLVD STE T
WESTMINSTER CA
92683-5341
US

IV. Provider business mailing address

PO BOX 10023
WESTMINSTER CA
92685-0023
US

V. Phone/Fax

Practice location:
  • Phone: 714-892-4922
  • Fax: 714-892-4942
Mailing address:
  • Phone: 714-892-4922
  • Fax: 714-892-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: