Provider Demographics
NPI:1174609127
Name:MONGA, MANOJ (MD)
Entity type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:
Last Name:MONGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:612-626-6666
Mailing Address - Fax:
Practice Address - Street 1:REGENTS OF THE UNIVERSITY OF CA - UCSD MEDICAL GROUP
Practice Address - Street 2:200 W. ARBOR DRIVE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:800-926-8273
Practice Address - Fax:888-539-8781
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81273208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
19-00018OtherMEDICA PRIMARY
095A9MOOtherBLUE CROSS BLUE SHIELD
1323616OtherARAZ
151586OtherUCARE
HP40403OtherHEALTH PARTNERS
WI34076300Medicaid
IA0545202Medicaid
1027813OtherPREFERRED ONE
19-00307OtherMEDICA CHOICE
MN407677000Medicaid
151586OtherUCARE
F32734Medicare UPIN
1323616OtherARAZ