MEDICARE: NORA EDELMIRA MONGE CPHW

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1225208473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORA EDELMIRA MONGE CPHW

Provider Business Mailing Address
First Line	:	2223 W 1ST ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-3505
Country	:	US
Telephone Number	:	714-973-9218
Fax Number	:	714-973-9269

Provider Business Practice Location Address
First Line	:	2223 W 1ST ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-3505
Country	:	US
Telephone Number	:	714-973-9218
Fax Number	:	714-973-9269

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

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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