Provider Demographics
NPI:1558771204
Name:MENTCH, MENAKA ASHWINI NAGESWARAN (MD)
Entity Type:Individual
Prefix:
First Name:MENAKA
Middle Name:ASHWINI NAGESWARAN
Last Name:MENTCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MENAKA
Other - Middle Name:ASHWINI
Other - Last Name:NAGESWARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:26522 LA ALAMEDA STE 370
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6330
Mailing Address - Country:US
Mailing Address - Phone:949-600-7864
Mailing Address - Fax:
Practice Address - Street 1:27700 MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6426
Practice Address - Country:US
Practice Address - Phone:949-364-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-04
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA160880207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology