Healthcare Provider Details

I. General information

NPI: 1750685780
Provider Name (Legal Business Name): MONA JASUJA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 S BRISTOL ST STE 101
SANTA ANA CA
92704-5751
US

IV. Provider business mailing address

2650 S BRISTOL ST STE 101
SANTA ANA CA
92704-5751
US

V. Phone/Fax

Practice location:
  • Phone: 714-754-1444
  • Fax:
Mailing address:
  • Phone: 714-754-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA115327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: