MEDICARE: SHANE MONDIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT25552	CA

General Provider Information

NPI Number	:	1053262972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE MONDIA

Provider Business Mailing Address
First Line	:	137 ROSEMONT AVE APT 12
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-5276
Country	:	US
Telephone Number	:	714-499-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 ROSEMONT AVE APT 12
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-5276
Country	:	US
Telephone Number	:	714-499-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “ SHANE MONDIA ” Practice Location

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