Provider Demographics
NPI:1134905748
Name:MONGE, DIANA (MPH, RDN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MONGE
Suffix:
Gender:F
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6522 BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1703
Mailing Address - Country:US
Mailing Address - Phone:323-243-6332
Mailing Address - Fax:
Practice Address - Street 1:6522 BUFFALO AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1703
Practice Address - Country:US
Practice Address - Phone:323-243-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86075352133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered