Provider Demographics
NPI:1750014239
Name:ILAGAN, MONIQUE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:ILAGAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7252 ARCHIBALD AVE # 1197
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5017
Mailing Address - Country:US
Mailing Address - Phone:909-781-4585
Mailing Address - Fax:
Practice Address - Street 1:7252 ARCHIBALD AVE # 1197
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-5017
Practice Address - Country:US
Practice Address - Phone:909-781-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-02
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist