Provider Demographics
NPI:1427363555
Name:VONJO, INGRID AZUCENA (PT)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:AZUCENA
Last Name:VONJO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:AZUCENA
Other - Last Name:CONTRERAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9140 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-2444
Mailing Address - Country:US
Mailing Address - Phone:562-801-4626
Mailing Address - Fax:562-801-4630
Practice Address - Street 1:9140 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2444
Practice Address - Country:US
Practice Address - Phone:562-801-4626
Practice Address - Fax:562-801-4630
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35093167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician