Healthcare Provider Details

I. General information

NPI: 1003140013
Provider Name (Legal Business Name): JOMARIE ESTEBAN MONZON-DULLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 ALDEN DRIVE
LOS ANGELES CA
90048
US

IV. Provider business mailing address

14017 RAVENWOOD DR
CHINO HILLS CA
91709-1790
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-0926
  • Fax:
Mailing address:
  • Phone: 323-580-9289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number698890
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: