Healthcare Provider Details

I. General information

NPI: 1780068882
Provider Name (Legal Business Name): MONA-GEKANJU TOEQUE M.D.,MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. MONA G TOEQUE

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 HOLLYWOOD BLVD
LOS ANGELES CA
90027-6101
US

IV. Provider business mailing address

6255 W SUNSET BLVD FL 21
LOS ANGELES CA
90028-7422
US

V. Phone/Fax

Practice location:
  • Phone: 323-662-0492
  • Fax: 323-662-0196
Mailing address:
  • Phone: 323-860-5200
  • Fax: 323-467-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA173822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: