Provider Demographics
NPI:1992175434
Name:MENGES, NANCY (PA-C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MENGES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3306 BIG CLOUD CIR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1027
Mailing Address - Country:US
Mailing Address - Phone:805-341-6507
Mailing Address - Fax:
Practice Address - Street 1:2925 SYCAMORE DR STE 204-205
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1207
Practice Address - Country:US
Practice Address - Phone:805-578-9620
Practice Address - Fax:805-955-0498
Is Sole Proprietor?:No
Enumeration Date:2015-09-27
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB283350Medicaid
CA1992175434OtherMEDI-CAL