Provider Demographics
NPI:1598520207
Name:MANONGDO, RICHMON
Entity Type:Individual
Prefix:
First Name:RICHMON
Middle Name:
Last Name:MANONGDO
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 1:3604 OCEAN RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-2669
Mailing Address - Country:US
Mailing Address - Phone:213-915-8277
Mailing Address - Fax:
Practice Address - Street 1:3604 OCEAN RANCH BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-2669
Practice Address - Country:US
Practice Address - Phone:213-915-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician