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NPI Code Detail

MEDICARE: MRS. ALLISON SMALLEY MONDRAGON FNP C MSN

MEDICARE: MRS. ALLISON SMALLEY MONDRAGON FNP C MSN
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
1363L00000XNurse Practitioner430289CA

General Provider Information

NPI Number : 1689663767
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ALLISON SMALLEY MONDRAGON FNP C MSN
Provider Business Mailing Address
First Line : 9914 W LILAC RD
Second Line :
City : ESCONDIDO
State : CA
Zip : 92026-5301
Country : US
Telephone Number : 909-273-9111
Fax Number :
Provider Business Practice Location Address
First Line : 9914 W LILAC RD
Second Line :
City : ESCONDIDO
State : CA
Zip : 92026-5301
Country : US
Telephone Number : 909-273-9111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 05/24/2011

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