Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95008193 | CA |
NPI | 1013414564 |
---|---|
Provider Name | Mrs. Jessica Alexandra Monzon |
First Address | Pasadena, CA 91104-4521 |
Second Address | Pasadena, CA 91104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2018 |
Last Update Date | 20/06/2018 |