Provider Demographics
NPI:1669003794
Name:MONDRAGON, TANIA EDITH
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:EDITH
Last Name:MONDRAGON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 CASSIDY ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-5316
Mailing Address - Country:US
Mailing Address - Phone:760-439-4577
Mailing Address - Fax:
Practice Address - Street 1:408 CASSIDY ST STE 103
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5316
Practice Address - Country:US
Practice Address - Phone:760-439-4577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner