Basic Information
| Provider Information | |||||||||
| NPI: | 1881737393 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENEGIO | ||||||||
| FirstName: | JANINA | ||||||||
| MiddleName: | CUDANES | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.P.T | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CUDANES | ||||||||
| OtherFirstName: | JANINA | ||||||||
| OtherMiddleName: | TESORO | ||||||||
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| OtherCredential: | D.P.T | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 21611 AUDUBON WAY | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926305752 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 17332 VON KARMAN AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926146242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498618600 | ||||||||
| FaxNumber: | 9498618601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 04/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 33366 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.