Individual
DR. JUAN CARLOS MENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4411 THE 25 WAY NE, SUITE 150, ALBUQUERQUE, NM 87109-5857
(505) 332-6900
(505) 332-6921
Mailing address
4411 THE 25 WAY NE, SUITE 150, ALBUQUERQUE, NM 87109-5857
(505) 332-6900
(505) 332-6921
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
20050716
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1492060
—
LA
01
—
2258272
MEDICARE GROUP
NM
05
—
45138
—
NM
05
—
52713
—
NM
01
—
600521002
MEDICARE IDTF
NM
05
—
68071019
—
NM
01
—
700521102
MEDICARE GROUP
NM
01
—
800521226
MEDICARE IDTF
NM
05
—
L0634
—
NM
Enumeration date
02/02/2006
Last updated
03/12/2014
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