Provider Demographics
NPI:1912030503
Name:MENELEY, BETHANNA MAIA (LAC)
Entity Type:Individual
Prefix:MS
First Name:BETHANNA
Middle Name:MAIA
Last Name:MENELEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10642 SANTA MONICA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4858
Mailing Address - Country:US
Mailing Address - Phone:310-775-3388
Mailing Address - Fax:
Practice Address - Street 1:10642 SANTA MONICA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4858
Practice Address - Country:US
Practice Address - Phone:310-775-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA10820171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist