Healthcare Provider Details

I. General information

NPI: 1447318498
Provider Name (Legal Business Name): ANJALI MONGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 LAGUNA CANYON RD STE 102
IRVINE CA
92618-2126
US

IV. Provider business mailing address

15825 LAGUNA CANYON RD STE 102
IRVINE CA
92618-2126
US

V. Phone/Fax

Practice location:
  • Phone: 949-733-2800
  • Fax: 949-733-2810
Mailing address:
  • Phone: 949-733-2800
  • Fax: 949-733-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA064282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: