Provider Demographics
NPI:1073165650
Name:MONGE, GENEVIEVE ELON (NP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:ELON
Last Name:MONGE
Suffix:
Gender:F
Credentials:NP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18651 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:92316-1831
Mailing Address - Country:US
Mailing Address - Phone:951-546-7520
Mailing Address - Fax:
Practice Address - Street 1:18651 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:CA
Practice Address - Zip Code:92316-1831
Practice Address - Country:US
Practice Address - Phone:909-546-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012200207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine