Provider Demographics
NPI:1245962786
Name:MENENDEZ, KEREN MARLA
Entity type:Individual
Prefix:
First Name:KEREN
Middle Name:MARLA
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JARD DE SALINAS 149
Mailing Address - Street 2:CALLE ROLANDO CRUZ
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-3152
Mailing Address - Country:US
Mailing Address - Phone:787-374-2004
Mailing Address - Fax:
Practice Address - Street 1:INTERCAMBIOS PUERTO RICO
Practice Address - Street 2:165 CALLE DIEGO ZALDUONDO
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-399-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program