Provider Demographics
NPI:1528283413
Name:MENCHACA, RAQUEL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:MENCHACA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MOUNTAIN BROOK DR
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-5230
Mailing Address - Country:US
Mailing Address - Phone:845-278-1677
Mailing Address - Fax:
Practice Address - Street 1:WESTCHESTER MEDICAL CENTER
Practice Address - Street 2:ELMWOOD HALL SECOND FLOOR
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-4050
Practice Address - Country:US
Practice Address - Phone:914-493-1639
Practice Address - Fax:914-493-1806
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301651363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health