Healthcare Provider Details

I. General information

NPI: 1760133110
Provider Name (Legal Business Name): MONDEGARI AND COHEN CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PIERRE RD STE A
WALNUT CA
91789-2565
US

IV. Provider business mailing address

100 PIERRE RD STE A
WALNUT CA
91789-2565
US

V. Phone/Fax

Practice location:
  • Phone: 909-999-0051
  • Fax: 909-954-5111
Mailing address:
  • Phone: 909-999-0051
  • Fax: 909-954-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KAMRAN MONDEGARI
Title or Position: CHIROPRACTOR
Credential: D.C
Phone: 925-876-6390