Provider Demographics
NPI:1790078046
Name:MENA, FROILAN (MA 61298)
Entity Type:Individual
Prefix:MR
First Name:FROILAN
Middle Name:
Last Name:MENA
Suffix:
Gender:M
Credentials:MA 61298
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 SW 87TH AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3245
Mailing Address - Country:US
Mailing Address - Phone:305-559-0054
Mailing Address - Fax:305-559-0053
Practice Address - Street 1:890 SW 87TH AVE STE 12
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3245
Practice Address - Country:US
Practice Address - Phone:305-559-0054
Practice Address - Fax:305-559-0053
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM26964261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy