Healthcare Provider Details

I. General information

NPI: 1033254420
Provider Name (Legal Business Name): GEORGINA MONCHO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N MADISON AVE
PASADENA CA
91101-1710
US

IV. Provider business mailing address

102 N MADISON AVE
PASADENA CA
91101-1710
US

V. Phone/Fax

Practice location:
  • Phone: 323-240-7987
  • Fax:
Mailing address:
  • Phone: 323-240-7987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21886
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: