Individual
JORGE ROBERTO MENJIVAR
Active
Individual
JORGE ROBERTO MENJIVAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN204394
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10006776
LICENSE
OR
01
—
865069
LICENSE
NV
01
—
95026632
LICENSE
CA
01
—
AP61443567
LICENSE
WA
01
—
RN204394
LICENSE
GA
Enumeration date
03/14/2017
Last updated
07/29/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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