=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073742904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONCHIT CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2009
-----------------------------------------------------
Last Update Date | 07/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16748 UKIAH ST
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92394-1488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-596-0378
-----------------------------------------------------
Fax | 760-596-0378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16748 UKIAH ST
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92394-1488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-596-0378
-----------------------------------------------------
Fax | 760-596-0378
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. RAMON CHITO F DE GUZMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-646-2439
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 366413166
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------