Basic Information
| Provider Information | |||||||||
| NPI: | 1174609127 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONGA | ||||||||
| FirstName: | MANOJ | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 232410 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921932410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126266666 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | REGENTS OF THE UNIVERSITY OF CA - UCSD MEDICAL GROUP | ||||||||
| Address2: | 200 W. ARBOR DRIVE | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921039000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009268273 | ||||||||
| FaxNumber: | 8885398781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 03/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | G81273 | CA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 19-00018 | 01 | MEDICA PRIMARY | OTHER | 095A9MO | 01 | BLUE CROSS BLUE SHIELD | OTHER | 1323616 | 01 | ARAZ | OTHER | 151586 | 01 | UCARE | OTHER | HP40403 | 01 | HEALTH PARTNERS | OTHER | 34076300 | 05 | WI | MEDICAID | 0545202 | 05 | IA | MEDICAID | 1027813 | 01 | PREFERRED ONE | OTHER | 19-00307 | 01 | MEDICA CHOICE | OTHER | 407677000 | 05 | MN | MEDICAID |