Organization
HARRY S MENCO MD , INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NICOLE MCCRACKEN (MEDICAL ASSISTANT)
(805) 496-2949
Entity
Organization
Contact information
Practice address
227 W JANSS RD, SUITE 310, THOUSAND OAKS, CA 91360-1848
(805) 496-2949
(805) 496-1844
Mailing address
227 W JANSS RD, SUITE 310, THOUSAND OAKS, CA 91360-1848
(805) 496-2949
(805) 496-1844
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
A41745
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A41745
PTAN
CA
Enumeration date
09/14/2010
Last updated
09/14/2010
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