Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | ME 102021 | FL |
NPI | 1144420753 |
---|---|
Provider Name | Jose Mena |
First Address | Miami, FL 33136-1005 |
Second Address | Miami, FL 33136-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2007 |
Last Update Date | 28/01/2013 |