1720164940 NPI number — MRS. ROSALINDA MARIA MENONI MD

Table of content: MRS. ROSALINDA MARIA MENONI MD (NPI 1720164940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720164940 NPI number — MRS. ROSALINDA MARIA MENONI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENONI
Provider First Name:
ROSALINDA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720164940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 685
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92324-0685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-486-4460
Provider Business Mailing Address Fax Number:
951-486-6510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 N INDIAN CANYON DRIVE
Provider Second Line Business Practice Location Address:
STE 214 EL MIRADOR
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-486-4460
Provider Business Practice Location Address Fax Number:
951-486-6510
Provider Enumeration Date:
10/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  G59780 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207T00000X , with the licence number: 036058470 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: L06417R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G597803 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".