Individual
MENA MESDAQ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6515 LA JOLLA BLVD, LA JOLLA, CA 92037-6066
(858) 454-7157
Mailing address
127 ROSEBAY DR, ENCINITAS, CA 92024-3323
(760) 807-3583
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
22646
CA
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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