Provider Demographics
NPI:1922055268
Name:MONINA HOME HEALTH, INC.
Entity Type:Organization
Organization Name:MONINA HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONINA
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:FERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:562-997-4213
Mailing Address - Street 1:3605 LONG BEACH BLVD
Mailing Address - Street 2:STE 321
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4013
Mailing Address - Country:US
Mailing Address - Phone:562-997-4213
Mailing Address - Fax:562-997-4006
Practice Address - Street 1:3605 LONG BEACH BLVD
Practice Address - Street 2:STE 321
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4013
Practice Address - Country:US
Practice Address - Phone:562-997-4213
Practice Address - Fax:562-997-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08162FMedicaid
CAHHA08162FMedicaid