Provider Demographics
NPI:1295627248
Name:MENJIVARDIAZ, MARIAELENA
Entity type:Individual
Prefix:
First Name:MARIAELENA
Middle Name:
Last Name:MENJIVARDIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 W AVENUE L10
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-3649
Mailing Address - Country:US
Mailing Address - Phone:661-547-6227
Mailing Address - Fax:
Practice Address - Street 1:5309 W AVENUE L10
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-3649
Practice Address - Country:US
Practice Address - Phone:661-547-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000077171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter