Provider Demographics
NPI:1013794684
Name:MENCHACA, MILENA (PA)
Entity type:Individual
Prefix:
First Name:MILENA
Middle Name:
Last Name:MENCHACA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MILENA
Other - Middle Name:
Other - Last Name:LADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 933421
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-5072
Mailing Address - Fax:937-641-6129
Practice Address - Street 1:3333 W TECH RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-0955
Practice Address - Country:US
Practice Address - Phone:376-415-7259
Practice Address - Fax:937-350-3050
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008366RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant