Basic Information
| Provider Information | |||||||||
| NPI: | 1073123485 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MENA | ||||||||
| FirstName: | CARINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 965 WILSON BLVD APT 1212 | ||||||||
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| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957627260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516036077 | ||||||||
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| Practice Location | |||||||||
| Address1: | 151 N SUNRISE AVE STE 1105 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956612931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167718255 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2020 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 21165 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.