Provider Demographics
NPI:1801437876
Name:TRUY MENCHACA, MARIANELA (NP)
Entity type:Individual
Prefix:
First Name:MARIANELA
Middle Name:
Last Name:TRUY MENCHACA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16537 SW 97TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5858
Mailing Address - Country:US
Mailing Address - Phone:786-307-7348
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:16283 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4912
Practice Address - Country:US
Practice Address - Phone:786-953-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily