Healthcare Provider Details

I. General information

NPI: 1467678268
Provider Name (Legal Business Name): MONA GWEN DUNAHOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7090 PARKWAY DR SUITE B
LA MESA CA
91942-1596
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD SUITE 300 N
CLACKAMAS OR
97015-5738
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-4327
  • Fax:
Mailing address:
  • Phone: 281-286-2999
  • Fax: 512-607-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA6084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: