Provider Demographics
NPI:1356102180
Name:MEJIA RUVALCABA, MONICA (LVN)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MEJIA RUVALCABA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 MISSION DR APT B
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4218
Mailing Address - Country:US
Mailing Address - Phone:714-721-7613
Mailing Address - Fax:
Practice Address - Street 1:330 E ORANGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-4313
Practice Address - Country:US
Practice Address - Phone:714-716-2584
Practice Address - Fax:714-971-2584
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA722972164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse