Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | PTCN666 | CA |
NPI | 1205460516 |
---|---|
Provider Name | Mr. Brian E Menjivar |
First Address | Mckinney, TX 75070-9532 |
Second Address | Mckinney, TX 75070-9532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2020 |
Last Update Date | 25/02/2020 |