Provider Demographics
NPI:1063996171
Name:NAOTALA, MONICA LYNN (RN)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNN
Last Name:NAOTALA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26249 PICTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4115
Mailing Address - Country:US
Mailing Address - Phone:909-810-6427
Mailing Address - Fax:
Practice Address - Street 1:26249 PICTON AVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4115
Practice Address - Country:US
Practice Address - Phone:909-810-6427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA785467163WH1000X, 163WP0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0200XNursing Service ProvidersRegistered NursePediatrics