Healthcare Provider Details

I. General information

NPI: 1831724129
Provider Name (Legal Business Name): MONIQUE VUONG RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 1804
LOS ANGELES CA
90067-2021
US

IV. Provider business mailing address

240 S ALMONT DR
BEVERLY HILLS CA
90211-2507
US

V. Phone/Fax

Practice location:
  • Phone: 424-239-9184
  • Fax:
Mailing address:
  • Phone: 424-239-9184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86091495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: