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General NPI Number Information
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NPI Number | 1013573625
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Entity Type | Individual
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Provider Name | MONVELEA MAKOR
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Gender | Female
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 9846 MISSION GORGE RD
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City | SANTEE
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State | CA
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Zip | 92071-3834
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Country | US
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Telephone | 619-449-0498
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Fax |
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Provider Business Mailing Address
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Address Line | 3766 SOUTHVIEW DR APT 207
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City | SAN DIEGO
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State | CA
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Zip | 92117-5333
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Country | US
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Telephone | 817-915-0415
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 34219
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License Number State | CA
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