Provider Demographics
NPI:1396329678
Name:MENGA, ROBERT (RN, BSN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MENGA
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3267 MOSS LANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-5362
Mailing Address - Country:US
Mailing Address - Phone:805-844-5692
Mailing Address - Fax:
Practice Address - Street 1:200 HILLMONT AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1647
Practice Address - Country:US
Practice Address - Phone:805-652-6729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA692703163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse