MEDICARE: FLORENTINO MENOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1144489568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLORENTINO MENOR

Provider Business Mailing Address
First Line	:	1307 MAYBERRY LN
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-3624
Country	:	US
Telephone Number	:	408-813-5455
Fax Number	:	408-907-8933

Provider Business Practice Location Address
First Line	:	1307 MAYBERRY LN
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-3624
Country	:	US
Telephone Number	:	408-813-5455
Fax Number	:	408-907-8933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	06/02/2008

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Directions to “ FLORENTINO MENOR ” Practice Location

Language	Start Address	Practice Location

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