Provider Demographics
NPI:1174994016
Name:VASQUEZ-ACAYTURRI, MONA
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:VASQUEZ-ACAYTURRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:VASQUEZ-ACAYTURRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:316 E E ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-3712
Mailing Address - Country:US
Mailing Address - Phone:909-983-4466
Mailing Address - Fax:
Practice Address - Street 1:316 E. E ST
Practice Address - Street 2:
Practice Address - City:ONATARIO
Practice Address - State:CA
Practice Address - Zip Code:91764
Practice Address - Country:US
Practice Address - Phone:909-983-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
171M00000XOtherCASE MANAGER/CARE COORDINATOR
171M00000XOtherCASE MANAGER/CARE COORDINATOR