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1104760511 NPI number — CAROLINA MENCHACA MARTINEZ

NPI Number: 1104760511
Health Care Provider/Practitioner: CAROLINA MENCHACA MARTINEZ

Information about “1104760511” NPI (CAROLINA MENCHACA MARTINEZ) exists in 1104760511 in HTML format HTML  |  1104760511 in plain Text format TXT  |  1104760511 in PDF (Portable Document Format) PDF  |  1104760511 in an XML format XML  formats.

NPI Number : 1104760511 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104760511",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MENCHACA MARTINEZ",
    "FirstName": "CAROLINA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "758 PENASCO GRANDE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PERRIS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92570-4555",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "951-422-8346",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7150 BROCKTON AVE STE 103",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIVERSIDE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92506-2614",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-683-6370",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/16/2026",
    "LastUpdateDate": "04/16/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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