Provider Demographics
NPI:1962075119
Name:MENA, MILDRED G
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:G
Last Name:MENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MILDRED
Other - Middle Name:G
Other - Last Name:MENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11841 OLD RIVER SCHOOL RD APT 101
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4666
Mailing Address - Country:US
Mailing Address - Phone:323-397-9716
Mailing Address - Fax:
Practice Address - Street 1:8135 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3158
Practice Address - Country:US
Practice Address - Phone:562-698-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43602355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant