Provider Demographics
NPI:1306839378
Name:MENA, MARIA MAGDALENA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:MAGDALENA
Last Name:MENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:733 NORTH 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4441
Mailing Address - Country:US
Mailing Address - Phone:352-435-7772
Mailing Address - Fax:352-435-7553
Practice Address - Street 1:733 NORTH 3RD STREET
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4441
Practice Address - Country:US
Practice Address - Phone:352-435-7772
Practice Address - Fax:352-435-7553
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2019-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 69780208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379673600Medicaid