Provider Demographics
NPI:1447318498
Name:MONGA, ANJALI (MD)
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:MONGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15825 LAGUNA CANYON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2126
Mailing Address - Country:US
Mailing Address - Phone:949-733-2800
Mailing Address - Fax:949-733-2810
Practice Address - Street 1:15825 LAGUNA CANYON RD STE 102
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2126
Practice Address - Country:US
Practice Address - Phone:949-733-2800
Practice Address - Fax:949-733-2810
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA064282173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330893127OtherTAX I.D.