Basic Information
| Provider Information | |||||||||
| NPI: | 1346533791 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENA | ||||||||
| FirstName: | EDGAR | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4205 W FIGARDEN DR | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937226051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592211680 | ||||||||
| FaxNumber: | 5592214336 | ||||||||
| Practice Location | |||||||||
| Address1: | 4205 W FIGARDEN DR | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937226051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592211680 | ||||||||
| FaxNumber: | 5592214336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2011 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.