Healthcare Provider Details

I. General information

NPI: 1568332344
Provider Name (Legal Business Name): JUAN CARLOS MONGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUAN CARLOS MONGE-SALAS MD

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 UPPER CANADA DRIVE
TORONTO ONTARIO
M2P 1S4
CA

IV. Provider business mailing address

96 UPPER CANADA DRIVE
TORONTO ONTARIO
M2P 1S4
CA

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0031384
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: