Healthcare Provider Details

I. General information

NPI: 1457528879
Provider Name (Legal Business Name): ANDREA MONIQUE JOURNAGIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 GROSSMONT CENTER DR
LA MESA CA
91942-3009
US

IV. Provider business mailing address

5525 GROSSMONT CENTER DR
LA MESA CA
91942-3009
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2702
  • Fax:
Mailing address:
  • Phone: 858-499-2702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD69150
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD0037997
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101248759
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC139892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: