Healthcare Provider Details

I. General information

NPI: 1841063047
Provider Name (Legal Business Name): MONREAL HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264 S WATERMAN AVE STE 33
SAN BERNARDINO CA
92408-2849
US

IV. Provider business mailing address

1130 N ORANGE ST APT 2
RIVERSIDE CA
92501
US

V. Phone/Fax

Practice location:
  • Phone: 619-513-2182
  • Fax:
Mailing address:
  • Phone: 619-513-2182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MELIDA PINA
Title or Position: CEO
Credential:
Phone: 619-513-2182