Provider Demographics
NPI:1891112223
Name:MADANI, MONA (MD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:MADANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 N PROSPECT AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3043
Mailing Address - Country:US
Mailing Address - Phone:424-437-4700
Mailing Address - Fax:424-437-8884
Practice Address - Street 1:520 N PROSPECT AVE STE 309
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3043
Practice Address - Country:US
Practice Address - Phone:244-374-7004
Practice Address - Fax:424-437-4700
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ54031207Q00000X
CAA171558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine