Provider Demographics
NPI:1164971479
Name:MADJDI, MONDANA (CBE)
Entity Type:Individual
Prefix:
First Name:MONDANA
Middle Name:
Last Name:MADJDI
Suffix:
Gender:F
Credentials:CBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 N BROOKLANE ST
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-2620
Mailing Address - Country:US
Mailing Address - Phone:360-528-0069
Mailing Address - Fax:
Practice Address - Street 1:1312 N BROOKLANE ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-2620
Practice Address - Country:US
Practice Address - Phone:360-528-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator