Provider Demographics
NPI:1740602838
Name:ESPANOLA, MONA
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:
Last Name:ESPANOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13891 NEWPORT AVE STE 285
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7840
Mailing Address - Country:US
Mailing Address - Phone:714-770-8222
Mailing Address - Fax:714-770-8228
Practice Address - Street 1:13891 NEWPORT AVE STE 285
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7840
Practice Address - Country:US
Practice Address - Phone:714-770-8222
Practice Address - Fax:714-770-8228
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist