Provider Demographics
NPI:1093404709
Name:MENARD, HARRISON LUKE
Entity Type:Individual
Prefix:
First Name:HARRISON
Middle Name:LUKE
Last Name:MENARD
Suffix:
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 1:12132 CONCORD CT
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2161
Mailing Address - Country:US
Mailing Address - Phone:907-982-7744
Mailing Address - Fax:
Practice Address - Street 1:12132 CONCORD CT
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2161
Practice Address - Country:US
Practice Address - Phone:907-982-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program