Provider Demographics
NPI:1689854077
Name:MENCHACA, JENNIFER PULIDO (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PULIDO
Last Name:MENCHACA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 W FREDDY GONZALEZ DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8391
Mailing Address - Country:US
Mailing Address - Phone:956-287-2100
Mailing Address - Fax:956-287-2111
Practice Address - Street 1:3521 W FREDDY GONZALEZ DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8391
Practice Address - Country:US
Practice Address - Phone:956-287-2100
Practice Address - Fax:956-287-2111
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05422363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05422OtherPA