Healthcare Provider Details

I. General information

NPI: 1932952116
Provider Name (Legal Business Name): LAISHA MONDESIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

9623 S 2ND AVE
INGLEWOOD CA
90305-3222
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-5600
  • Fax:
Mailing address:
  • Phone: 323-449-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: