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General NPI Number Information
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NPI Number | 1225031289
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Entity Type | Individual
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Provider Name | JORGE LUIS MENENDEZ MD,FACS
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 07/15/2007
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Provider Practice Location Address
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Address Line | 7744 BROADWAY ST STE 210
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City | SAN ANTONIO
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State | TX
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Zip | 78209-3262
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Country | US
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Telephone | 210-829-7411
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Fax | 210-829-7899
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Provider Business Mailing Address
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Address Line | PO BOX 91199
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City | SAN ANTONIO
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State | TX
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Zip | 78209-9097
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Country | US
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Telephone | 210-829-7411
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Fax | 210-829-7899
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G8281
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License Number State | TX
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