Provider Demographics
NPI:1649757584
Name:MENENDEZ, LISSET A
Entity Type:Individual
Prefix:
First Name:LISSET
Middle Name:A
Last Name:MENENDEZ
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 1:19809 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-6504
Mailing Address - Country:US
Mailing Address - Phone:818-717-1000
Mailing Address - Fax:
Practice Address - Street 1:19809 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-6504
Practice Address - Country:US
Practice Address - Phone:818-717-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator