1720385313 NPI number — MONARCH MEDICAL MANGEMENT, INC.

Table of content: (NPI 1720385313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720385313 NPI number — MONARCH MEDICAL MANGEMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONARCH MEDICAL MANGEMENT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1720385313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13132 NEWPORT AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSTIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92780-3429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-368-3332
Provider Business Mailing Address Fax Number:
714-773-5806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3711 N HARBOR BLVD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92835-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-773-4107
Provider Business Practice Location Address Fax Number:
714-773-5806
Provider Enumeration Date:
02/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CONTRERAS
Authorized Official First Name:
K.C.
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL MANAGER BILLER
Authorized Official Telephone Number:
714-773-4107

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  A31234 , 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)





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