Provider Demographics
NPI:1568183671
Name:MENA-ORTIZ, KARLA D
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:D
Last Name:MENA-ORTIZ
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 1:2655 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1666
Mailing Address - Country:US
Mailing Address - Phone:775-688-1600
Mailing Address - Fax:
Practice Address - Street 1:3732 LAKESIDE DR STE 202
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4519
Practice Address - Country:US
Practice Address - Phone:775-686-9607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health