Provider Demographics
NPI:1376195933
Name:MENJIVAR, PAULINA BEATRIZ
Entity Type:Individual
Prefix:
First Name:PAULINA
Middle Name:BEATRIZ
Last Name:MENJIVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 60TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1381
Mailing Address - Country:US
Mailing Address - Phone:347-430-0934
Mailing Address - Fax:
Practice Address - Street 1:645 60TH ST APT 6
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1381
Practice Address - Country:US
Practice Address - Phone:347-430-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-14
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty