Provider Demographics
NPI:1215359377
Name:MENON, GIRIJA (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:GIRIJA
Middle Name:
Last Name:MENON
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:GIRIJA
Other - Middle Name:MENON
Other - Last Name:RADHAMANIAMMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:COMMUNITY BRIDGES INC
Mailing Address - Street 2:1855 W BASELINE RD STE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-831-7566
Mailing Address - Fax:480-775-2466
Practice Address - Street 1:COMMUNITY BRIDGES INC
Practice Address - Street 2:1855 W BASELINE RD STE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-831-7566
Practice Address - Fax:480-775-2466
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5325363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner