Doctor Name: | JENNIFER SUZANNE MENETREZ |
NPI Number: | 1023008737 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 0101047018 |
Business Practice Address: | 3851 Roger Brooke Dr Physical Medicine Service, Bamc San Antonio, TX - 782344501 |
Business Phone Number: | 2109160306 |
Business Fax Number: | 2109160598 |
Mailing Address: | 13511 Maple Brook Dr, SAN ANTONIO |
State: | TX |
Postal Code: | 782325174 |
Phone Number: | 2104020991 |
Fax Number: | |
NPI Enumeration Date: | 10/24/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | 0101047018 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |