MEDICARE: SONYA MONDRAGON

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	225100000X	Physical Therapist	38498	CA

General Provider Information

NPI Number	:	1710224183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONYA MONDRAGON

Provider Business Mailing Address
First Line	:	27343 RYAN DR
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-3591
Country	:	US
Telephone Number	:	818-357-6676
Fax Number	:

Provider Business Practice Location Address
First Line	:	34241 PACIFIC COAST HWY
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-3845
Country	:	US
Telephone Number	:	949-496-3896
Fax Number	:

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

Provider Enumeration Date	:	01/05/2013
Last Update Date	:	01/05/2013

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Directions to “ SONYA MONDRAGON ” Practice Location

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