Individual provider Active NPI

Darlene Mulyanto-Mong

  • Acute Care Nurse Practitioner
  • Orange, CA
National Provider Identifier
1255873717
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
95004975 Issued in CA
Practice address
101 The City Dr S
Orange, CA 92868-3201
Phone
(714) 456-7890
NPI assigned
Nov 14, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 95004975 CA Primary

Addresses

Primary practice location

101 The City Dr S
Orange, CA 92868-3201

Mailing address

1038 Oban Dr
Los Angeles, CA 90065-4257

Other practice location 1

2051 Marengo St
Los Angeles, CA 90033-1352
Phone (323) 409-1000

Other practice location 2

14445 Olive View Dr
North Annex
Sylmar, CA 91342-1437
Phone (818) 364-1555

Other practice location 3

1500 San Pablo St
Los Angeles, CA 90033-5313
Phone (800) 872-2273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161222000854 CA Practitioner - Nurse Practitioner 9335420710 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95004975CAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Dec 15, 2016 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Oct 1, 2022 Accepting new patients
Prohealth Partners a Medical Group CurrentSince Aug 29, 2022 Accepting new patients
Willow Brook Critical Care Medical Group, Inc CurrentSince Mar 1, 2020 Accepting new patients
County of Los Angeles Auditor Controller CurrentSince Dec 15, 2016 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Oct 1, 2022 Accepting new patients
Prohealth Partners, a Medical Group, Inc. CurrentSince Aug 29, 2022 Accepting new patients
County of Los Angeles Current Accepting new patients
Prohealth Partners, a Medical Group Current Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1420 S Central Ave
Glendale, CA 91204
Phone (818) 502-1900

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1245 Wilshire Blvd
Ste 703
Los Angeles, CA 90017
Phone (213) 977-0419

2051 Marengo St
Los Angeles, CA 90033
Phone (323) 409-2800

File 54567
Los Angeles, CA 90074
Phone (310) 491-9060

1500 San Pablo St
Los Angeles, CA 90033
Phone (323) 443-8500

3630 E Imperial Hwy
Lynwood, CA 90262
Phone (310) 900-7420

14445 Olive View Dr
#2C155
Sylmar, CA 91342
Phone (818) 364-3001

14445 Olive View Dr
Sylmar, CA 91342
Phone (881) 836-4303

4201 Torrance Blvd
Ste 350
Torrance, CA 90503
Phone (310) 540-5494

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788393600000",
    "number": "1255873717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1038 OBAN DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900654257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-456-7890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2051 Marengo St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900331352",
            "country_code": "US",
            "telephone_number": "323-409-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14445 Olive View Dr",
            "address_2": "North Annex",
            "address_purpose": "LOCATION",
            "city": "Sylmar",
            "state": "CA",
            "postal_code": "913421437",
            "country_code": "US",
            "telephone_number": "818-364-1555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 San Pablo St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900335313",
            "country_code": "US",
            "telephone_number": "800-872-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULYANTO-MONG",
        "first_name": "DARLENE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-14",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95004975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.