Provider Demographics
NPI:1780142026
Name:MUONGPRUAN, MANORAH (MS)
Entity type:Individual
Prefix:MS
First Name:MANORAH
Middle Name:
Last Name:MUONGPRUAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:NORA
Other - Middle Name:
Other - Last Name:MUONGPRUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8395 MAGNOLIA AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3225
Mailing Address - Country:US
Mailing Address - Phone:909-844-4610
Mailing Address - Fax:
Practice Address - Street 1:7177 BROCKTON AVE STE 452
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2635
Practice Address - Country:US
Practice Address - Phone:951-682-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor