Provider Demographics
NPI:1811032550
Name:EDWARD A. MENA, M.D., INC
Entity Type:Organization
Organization Name:EDWARD A. MENA, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-440-7325
Mailing Address - Street 1:301 S FAIR OAKS AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2562
Mailing Address - Country:US
Mailing Address - Phone:266-440-7325
Mailing Address - Fax:626-440-7310
Practice Address - Street 1:301 S FAIR OAKS AVE STE 305
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2562
Practice Address - Country:US
Practice Address - Phone:266-440-7325
Practice Address - Fax:266-440-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73231207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA73231OtherMEDICAL LICENSE
CA1881654226OtherPERSONAL NPI
CAA73231OtherMEDICAL LICENSE
CAA73231OtherMEDICAL LICENSE