Provider Demographics
NPI:1811101603
Name:MITCHELL, MONSERATE (LVN)
Entity type:Individual
Prefix:
First Name:MONSERATE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MONSERATE
Other - Middle Name:MORENO
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1640 MAPLE DR
Mailing Address - Street 2:UNIT 71
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-5942
Mailing Address - Country:US
Mailing Address - Phone:619-425-5448
Mailing Address - Fax:
Practice Address - Street 1:1640 MAPLE DR
Practice Address - Street 2:UNIT 71
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-5942
Practice Address - Country:US
Practice Address - Phone:619-425-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN207724164X00000X
CA37-07261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered164X00000XNursing Service ProvidersLicensed Vocational Nurse
Not Answered261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone