Provider Demographics
NPI:1528419348
Name:KAMANTIGUE, ACE MONZON (NP)
Entity Type:Individual
Prefix:MR
First Name:ACE
Middle Name:MONZON
Last Name:KAMANTIGUE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10571 PONDEROSA CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3866
Mailing Address - Country:US
Mailing Address - Phone:714-747-1830
Mailing Address - Fax:562-944-1869
Practice Address - Street 1:10571 PONDEROSA CIR
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3866
Practice Address - Country:US
Practice Address - Phone:714-747-1830
Practice Address - Fax:562-944-1869
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA720659163W00000X
CA95006726363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse