Healthcare Provider Details

I. General information

NPI: 1821382045
Provider Name (Legal Business Name): ANGEL JAVIER MENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

4685 FOREST AVE SUITE C
CINCINNATI OH
45212-3397
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-2563
  • Fax: 513-751-8638
Mailing address:
  • Phone: 513-853-4721
  • Fax: 513-852-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.123759
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.123759
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: