Provider Demographics
NPI:1700238052
Name:MONDEJAR, PHILIP ROJAS (R N)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ROJAS
Last Name:MONDEJAR
Suffix:
Gender:M
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 N DELAWARE ST
Mailing Address - Street 2:APT. #2
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-1500
Mailing Address - Country:US
Mailing Address - Phone:650-440-3102
Mailing Address - Fax:
Practice Address - Street 1:809 N DELAWARE ST
Practice Address - Street 2:APT. #2
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-1500
Practice Address - Country:US
Practice Address - Phone:650-440-3102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95090307163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse