Provider Demographics
NPI:1134542723
Name:MONICA
Entity type:Organization
Organization Name:MONICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITIZEN
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:9/2/1992
Authorized Official - Phone:619-755-2830
Mailing Address - Street 1:277 FRANCIS ST
Mailing Address - Street 2:277
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4436
Mailing Address - Country:US
Mailing Address - Phone:619-755-2830
Mailing Address - Fax:
Practice Address - Street 1:277 FRANCIS ST
Practice Address - Street 2:277
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4436
Practice Address - Country:US
Practice Address - Phone:619-755-2830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIDA ESPINOZA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-02
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution