Healthcare Provider Details

I. General information

NPI: 1114653318
Provider Name (Legal Business Name): LUCAS MENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 VISION BLVD
ORLANDO FL
32839-8808
US

IV. Provider business mailing address

9857 LELAND DR
ORLANDO FL
32827-5745
US

V. Phone/Fax

Practice location:
  • Phone: 407-836-3400
  • Fax:
Mailing address:
  • Phone: 347-397-9051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME182482
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11042037
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: