Healthcare Provider Details

I. General information

NPI: 1962075119
Provider Name (Legal Business Name): MILDRED G MENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MILDRED G MENA

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 PAINTER AVE
WHITTIER CA
90602-3158
US

IV. Provider business mailing address

11841 OLD RIVER SCHOOL RD APT 101
DOWNEY CA
90241-4666
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-6600
  • Fax:
Mailing address:
  • Phone: 323-397-9716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number4360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: