Healthcare Provider Details

I. General information

NPI: 1073742904
Provider Name (Legal Business Name): MONCHIT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16748 UKIAH ST
VICTORVILLE CA
92394-1488
US

IV. Provider business mailing address

16748 UKIAH ST
VICTORVILLE CA
92394-1488
US

V. Phone/Fax

Practice location:
  • Phone: 760-596-0378
  • Fax: 760-596-0378
Mailing address:
  • Phone: 760-596-0378
  • Fax: 760-596-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number366413166
License Number StateCA

VIII. Authorized Official

Name: MR. RAMON CHITO F DE GUZMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 760-646-2439