Provider Demographics
NPI:1407022411
Name:MENCHACA, JOE ALBERT SR (BA SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:ALBERT
Last Name:MENCHACA
Suffix:SR
Gender:M
Credentials:BA SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 E BELGRAVIA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-3434
Mailing Address - Country:US
Mailing Address - Phone:559-264-2932
Mailing Address - Fax:
Practice Address - Street 1:2904 E BELGRAVIA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-3434
Practice Address - Country:US
Practice Address - Phone:559-264-2932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7421OtherCAARR