Basic Information
| Provider Information | |||||||||
| NPI: | 1376816371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONCIVALLES | ||||||||
| FirstName: | YVONNE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 WARNER AVE UNIT 175 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926475272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147718000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6600 WARNER AVE. | ||||||||
| Address2: | #175 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147718000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2012 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 500448 | CA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | NP 21673 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.