Provider Demographics
NPI:1811284219
Name:MENCIAS, IRIS JOLLY JOANNA CASTILLO (MD)
Entity type:Individual
Prefix:DR
First Name:IRIS JOLLY JOANNA
Middle Name:CASTILLO
Last Name:MENCIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IRIS JOLLY JOANNA
Other - Middle Name:MENCIAS
Other - Last Name:RICHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:21231 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5501
Mailing Address - Country:US
Mailing Address - Phone:310-540-1711
Mailing Address - Fax:
Practice Address - Street 1:21231 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5501
Practice Address - Country:US
Practice Address - Phone:310-540-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113545207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)