Provider Demographics
NPI:1356589055
Name:VICTORIA A MENCHACA PHD A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:VICTORIA A MENCHACA PHD A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MENCHACA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-938-0748
Mailing Address - Street 1:PO BOX 741808
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-8808
Mailing Address - Country:US
Mailing Address - Phone:323-938-0748
Mailing Address - Fax:
Practice Address - Street 1:265 S. WESTERN AVE
Practice Address - Street 2:SUITE 741808
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-8808
Practice Address - Country:US
Practice Address - Phone:323-938-0748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10969261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY10969OtherCA PSYCHOLOGY LICENSURE
CAPSY109690Medicaid
CAPSY10969OtherCA PSYCHOLOGY LICENSURE