Healthcare Provider Details

I. General information

NPI: 1376963074
Provider Name (Legal Business Name): MONA DENHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N CENTRAL AVE UNIT 750
GLENDALE CA
91203-3324
US

IV. Provider business mailing address

5901 W CENTURY BLVD
LOS ANGELES CA
90045-5411
US

V. Phone/Fax

Practice location:
  • Phone: 818-557-0135
  • Fax:
Mailing address:
  • Phone: 310-491-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704267818
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95011073
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209011486041419613
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: