Provider Demographics
NPI:1275910853
Name:MENJIVAR, LUCY (LVN)
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:
Last Name:MENJIVAR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14822 MAYTEN AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-2656
Mailing Address - Country:US
Mailing Address - Phone:949-294-7392
Mailing Address - Fax:
Practice Address - Street 1:14822 MAYTEN AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-2656
Practice Address - Country:US
Practice Address - Phone:949-294-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-02
Last Update Date:2015-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN227478164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse