Healthcare Provider Details

I. General information

NPI: 1942138391
Provider Name (Legal Business Name): NALLY MENA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. FACTOR 56 CALLE BRINDIS
ARECIBO PR
00612-6840
US

IV. Provider business mailing address

URB. FACTOR 56 CALLE BRINDIS
ARECIBO PR
00612-6840
US

V. Phone/Fax

Practice location:
  • Phone: 787-629-4660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1061
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: