Provider Demographics
NPI:1205918141
Name:MENA-GONZALEZ, NERIE L (PT)
Entity type:Individual
Prefix:MS
First Name:NERIE
Middle Name:L
Last Name:MENA-GONZALEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6018
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6018
Mailing Address - Country:US
Mailing Address - Phone:787-374-2070
Mailing Address - Fax:
Practice Address - Street 1:304 CALLE VISTA BAHIA
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-8310
Practice Address - Country:US
Practice Address - Phone:787-374-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR005-8454Medicare PIN