Provider Demographics
NPI:1720385313
Name:MONARCH MEDICAL MANGEMENT, INC.
Entity Type:Organization
Organization Name:MONARCH MEDICAL MANGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL MANAGER BILLER
Authorized Official - Prefix:MISS
Authorized Official - First Name:K.C.
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA/LVN
Authorized Official - Phone:714-773-4107
Mailing Address - Street 1:13132 NEWPORT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3429
Mailing Address - Country:US
Mailing Address - Phone:714-368-3332
Mailing Address - Fax:714-773-5806
Practice Address - Street 1:3711 N HARBOR BLVD STE C
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1362
Practice Address - Country:US
Practice Address - Phone:714-773-4107
Practice Address - Fax:714-773-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31234302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID