Provider Demographics
NPI:1497394621
Name:GARGA, MONI JULIUS
Entity Type:Individual
Prefix:
First Name:MONI
Middle Name:JULIUS
Last Name:GARGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9116 LAGUNA PLACE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5359
Mailing Address - Country:US
Mailing Address - Phone:916-690-7177
Mailing Address - Fax:
Practice Address - Street 1:9116 LAGUNA PLACE WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5359
Practice Address - Country:US
Practice Address - Phone:916-690-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALIC19-003102343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)