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NPI Code Detail

MEDICARE: MRS. REBECCA MARISSA MENA FNP

MEDICARE: MRS. REBECCA MARISSA MENA FNP
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
1363LF0000XFamily Nurse Practitioner95021339CA

General Provider Information

NPI Number : 1689305070
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA MARISSA MENA FNP
Provider Business Mailing Address
First Line : 1016 HICKS ST
Second Line :
City : SELMA
State : CA
Zip : 93662-4349
Country : US
Telephone Number : 559-356-9362
Fax Number :
Provider Business Practice Location Address
First Line : 2021 HERNDON AVE STE 101
Second Line :
City : CLOVIS
State : CA
Zip : 93611-6316
Country : US
Telephone Number : 559-797-4315
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2022
Last Update Date : 06/17/2022

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