Provider Demographics
NPI:1033851100
Name:MENCHACA, ROBERTO III
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:MENCHACA
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 BRAESVIEW APT 2210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4809
Mailing Address - Country:US
Mailing Address - Phone:830-388-1556
Mailing Address - Fax:
Practice Address - Street 1:11800 BRAESVIEW APT 2210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4809
Practice Address - Country:US
Practice Address - Phone:830-388-1556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty