Healthcare Provider Details

I. General information

NPI: 1790919124
Provider Name (Legal Business Name): EMMANUEL N MENGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST STE 1263
MIAMI FL
33136-2107
US

IV. Provider business mailing address

1120 NW 14TH ST STE 1263
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-3208
  • Fax: 585-756-4726
Mailing address:
  • Phone: 305-243-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberQ4466
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number288799
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number165837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: