Healthcare Provider Details

I. General information

NPI: 1437664927
Provider Name (Legal Business Name): MONA ORTON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 10/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MARKET ST
RIVERSIDE CA
92501-1720
US

IV. Provider business mailing address

615 E LUGONIA AVE APT 3
REDLANDS CA
92374-2487
US

V. Phone/Fax

Practice location:
  • Phone: 951-530-5900
  • Fax:
Mailing address:
  • Phone: 909-238-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number115163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: