Healthcare Provider Details

I. General information

NPI: 1891242095
Provider Name (Legal Business Name): DANILA DE MENECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 LOUIS AVE
WINDSOR ONTARIO
N9A1Y2
CA

IV. Provider business mailing address

1058 LOUIS AVE
WINDSOR ONTARIO
N9A1Y2
CA

V. Phone/Fax

Practice location:
  • Phone: 519-984-9181
  • Fax:
Mailing address:
  • Phone: 519-984-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: