Provider Demographics
NPI:1184865008
Name:MONG, SANDY (MD)
Entity type:Individual
Prefix:MISS
First Name:SANDY
Middle Name:
Last Name:MONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 CERRO LARGO DR
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1713
Mailing Address - Country:US
Mailing Address - Phone:206-679-2836
Mailing Address - Fax:858-793-8471
Practice Address - Street 1:1135 CERRO LARGO DR
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1713
Practice Address - Country:US
Practice Address - Phone:206-679-2836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program