Provider Demographics
NPI:1144489568
Name:MENOR, FLORENTINO
Entity type:Individual
Prefix:
First Name:FLORENTINO
Middle Name:
Last Name:MENOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 MAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-3624
Mailing Address - Country:US
Mailing Address - Phone:408-813-5455
Mailing Address - Fax:408-907-8933
Practice Address - Street 1:1307 MAYBERRY LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-3624
Practice Address - Country:US
Practice Address - Phone:408-813-5455
Practice Address - Fax:408-907-8933
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker