Provider Demographics
NPI:1174826267
Name:MENA, YAQUELINE (LMT)
Entity Type:Individual
Prefix:
First Name:YAQUELINE
Middle Name:
Last Name:MENA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7925 NW 12TH ST
Mailing Address - Street 2:SUITE # 229
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1827
Mailing Address - Country:US
Mailing Address - Phone:305-597-7361
Mailing Address - Fax:305-597-7364
Practice Address - Street 1:7925 NW 12TH ST
Practice Address - Street 2:SUITE # 229
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1827
Practice Address - Country:US
Practice Address - Phone:305-597-7361
Practice Address - Fax:305-597-7364
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60770111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation