Provider Demographics
NPI:1457231649
Name:MENA, RUDY JUSTIN
Entity type:Individual
Prefix:
First Name:RUDY
Middle Name:JUSTIN
Last Name:MENA
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 1:913 WILLOW ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2380
Mailing Address - Country:US
Mailing Address - Phone:408-883-1695
Mailing Address - Fax:
Practice Address - Street 1:913 WILLOW ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-2380
Practice Address - Country:US
Practice Address - Phone:408-883-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist