Healthcare Provider Details

I. General information

NPI: 1194648360
Provider Name (Legal Business Name): MONA JANBOZORGI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E SPOKANE FALLS BLVD,
SPOKANE WA
99202
US

IV. Provider business mailing address

3024 E JACKSON AVE APT 308
SPOKANE WA
99207-5560
US

V. Phone/Fax

Practice location:
  • Phone: 509-368-6700
  • Fax:
Mailing address:
  • Phone: 979-900-6263
  • 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 StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: