Provider Demographics
NPI:1992270987
Name:MENESES, MOISES FABIAN JR (CF-SLP)
Entity type:Individual
Prefix:MR
First Name:MOISES
Middle Name:FABIAN
Last Name:MENESES
Suffix:JR
Gender:M
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29516 KOHOUTEK WAY
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1221
Mailing Address - Country:US
Mailing Address - Phone:510-441-8240
Mailing Address - Fax:
Practice Address - Street 1:29516 KOHOUTEK WAY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1221
Practice Address - Country:US
Practice Address - Phone:510-441-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12912235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty