Healthcare Provider Details

I. General information

NPI: 1073633301
Provider Name (Legal Business Name): MONA ATTALLA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W PUTNAM AVE 2A
PORTERVILLE CA
93257-3257
US

IV. Provider business mailing address

590 W PUTNAM AVE 2A
PORTERVILLE CA
93257-3257
US

V. Phone/Fax

Practice location:
  • Phone: 559-781-3700
  • Fax: 559-781-4350
Mailing address:
  • Phone: 559-781-3700
  • Fax: 559-781-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: