Provider Demographics
NPI:1477573111
Name:MENCHACA, DENISE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:MENCHACA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 LA VENTA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3703
Mailing Address - Country:US
Mailing Address - Phone:805-777-7370
Mailing Address - Fax:805-777-7380
Practice Address - Street 1:110 JENSEN CT
Practice Address - Street 2:SUITE 2C
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7483
Practice Address - Country:US
Practice Address - Phone:805-413-1070
Practice Address - Fax:805-413-1076
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28913OtherPT LICENSE
CA1558498337OtherTO GROUP NPI #
CA1043236078OtherWLV GROUP NPI #