Provider Demographics
NPI:1578856720
Name:MENCHACA, CHRIS
Entity Type:Individual
Prefix:MRS
First Name:CHRIS
Middle Name:
Last Name:MENCHACA
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 1:2309 W SONOMA CT
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4359
Mailing Address - Country:US
Mailing Address - Phone:208-859-4216
Mailing Address - Fax:
Practice Address - Street 1:2309 W SONOMA CT
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4359
Practice Address - Country:US
Practice Address - Phone:208-859-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant