Healthcare Provider Details

I. General information

NPI: 1407116064
Provider Name (Legal Business Name): FROILAN FELIPE M. MATONDO REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 PARK CENTER DR
SANTEE CA
92071-6957
US

IV. Provider business mailing address

5958 RANCHO MISSION RD UNIT 206
SAN DIEGO CA
92108-2549
US

V. Phone/Fax

Practice location:
  • Phone: 619-596-5500
  • Fax:
Mailing address:
  • Phone: 619-684-5235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number795893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: