Provider Demographics
NPI:1699455907
Name:MONGE, NATALIE SOPHIA
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:SOPHIA
Last Name:MONGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 BACHELOT ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1742
Mailing Address - Country:US
Mailing Address - Phone:310-490-8684
Mailing Address - Fax:
Practice Address - Street 1:2500 CAMPUS RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2217
Practice Address - Country:US
Practice Address - Phone:808-956-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty