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General NPI Number Information
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NPI Number | 1093228926
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Entity Type | Individual
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Provider Name | MONEMALA PHILAVONG-DANH NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 330 W RAMSEY ST
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City | BANNING
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State | CA
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Zip | 92220-4823
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Country | US
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Telephone | 951-849-1950
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Fax |
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Provider Business Mailing Address
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Address Line | 10590 TOWN CENTER DR STE 170
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0361
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Country | US
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Telephone | 909-483-0000
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F08170474
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95008033
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License Number State | CA
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