Healthcare Provider Details

I. General information

NPI: 1568393650
Provider Name (Legal Business Name): ALEJANDRA G MONDRAGON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28800 REVIERE DR
MENIFEE CA
92584-8972
US

IV. Provider business mailing address

40525 REVERE AVE
HEMET CA
92544-4634
US

V. Phone/Fax

Practice location:
  • Phone: 951-672-6420
  • Fax:
Mailing address:
  • Phone: 951-552-4792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number740198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: