Provider Demographics
NPI:1679793376
Name:MENA, ISMAEL (DO)
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:
Last Name:MENA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7499 CERRITOS AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-2008
Mailing Address - Country:US
Mailing Address - Phone:714-827-5180
Mailing Address - Fax:714-827-9993
Practice Address - Street 1:7499 CERRITOS AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-2008
Practice Address - Country:US
Practice Address - Phone:714-827-5180
Practice Address - Fax:714-827-9993
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH81110Medicare UPIN