Provider Demographics
NPI:1639211162
Name:MENTA, MIGUEL D
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:D
Last Name:MENTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9265 DOWDY DR
Mailing Address - Street 2:STE 211
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6370
Mailing Address - Country:US
Mailing Address - Phone:858-549-1045
Mailing Address - Fax:858-549-1030
Practice Address - Street 1:9265 DOWDY DR
Practice Address - Street 2:STE 211
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-6370
Practice Address - Country:US
Practice Address - Phone:858-549-1045
Practice Address - Fax:858-549-1030
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver