Provider Demographics
NPI:1518337773
Name:MENESES, PAULINA
Entity type:Individual
Prefix:MRS
First Name:PAULINA
Middle Name:
Last Name:MENESES
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 1:1204 BOWMAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-5168
Mailing Address - Country:US
Mailing Address - Phone:254-485-5389
Mailing Address - Fax:
Practice Address - Street 1:1208 BOWMAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-5168
Practice Address - Country:US
Practice Address - Phone:254-434-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143145310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility