Mondell Pine Manor I

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MONDELL PINE MANOR I

Practice address

39046 Mondell Pine Ave
Palmdale, CA 93551-6042

Phone

(818) 332-6150

Fax

(805) 578-9486

NPI assigned

Jul 11, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Jerome Viray

Title

Licensee

Phone

(818) 332-6150

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1720656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1508603986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1716 ERRINGER RD STE 104",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930656506",
            "telephone_number": "818-332-6150",
            "fax_number": "805-578-9486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39046 MONDELL PINE AVE",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935516042",
            "telephone_number": "818-332-6150",
            "fax_number": "805-578-9486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONDELL PINE MANOR I",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-11",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "VIRAY",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "818-332-6150",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Mojarro
• Pejman Mokhtar, DDS
• Tanya Jocelyn Mollings
• Monarch Behavior Services, Inc
• Juan Moncada Lule
• Mondell Pine Manor II
• Elizabeth Ashley Monroe, M.S., BCBA
• Margarita Ann Monroy
• Peyman Monsef, D.D.S.
• Lupita Reyes Montano

• Assisted Living Facility in Palmdale, CA
• Providers in Palmdale, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.