Provider Demographics
NPI:1124182050
Name:CHUA, MONPRAPA (OD)
Entity Type:Individual
Prefix:
First Name:MONPRAPA
Middle Name:
Last Name:CHUA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27058 MAPLE TREE CT
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91381-0609
Mailing Address - Country:US
Mailing Address - Phone:661-284-2838
Mailing Address - Fax:
Practice Address - Street 1:2223 S MOONEY BLVD
Practice Address - Street 2:#820
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-6243
Practice Address - Country:US
Practice Address - Phone:209-739-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU83591Medicare UPIN
CASD0114660Medicare ID - Type Unspecified