1174609127 NPI number — DR. MANOJ MONGA MD

Table of content: DR. MANOJ MONGA MD (NPI 1174609127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174609127 NPI number — DR. MANOJ MONGA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONGA
Provider First Name:
MANOJ
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1174609127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 232410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92193-2410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-626-6666
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
REGENTS OF THE UNIVERSITY OF CA - UCSD MEDICAL GROUP
Provider Second Line Business Practice Location Address:
200 W. ARBOR DRIVE
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-926-8273
Provider Business Practice Location Address Fax Number:
888-539-8781
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: 208800000X , with the licence number:  G81273 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 19-00018 . This is a "MEDICA PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 095A9MO . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1323616 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 151586 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP40403 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34076300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0545202 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1027813 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19-00307 . This is a "MEDICA CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 407677000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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