Provider Demographics
NPI:1437515582
Name:MENA, JESSICA LISSETH (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LISSETH
Last Name:MENA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 WOODMAN AVE
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-5427
Mailing Address - Country:US
Mailing Address - Phone:818-375-3458
Mailing Address - Fax:
Practice Address - Street 1:8250 WOODMAN AVE
Practice Address - Street 2:BUILDING 2
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5427
Practice Address - Country:US
Practice Address - Phone:818-375-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist