Individual provider Active NPI

Maria D Ronquillo, NP

  • Nurse Practitioner
  • Monterey Park, CA
National Provider Identifier
1518032762
Registry record updated May 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NP13432 Issued in CA
Practice address
850 S Atlantic Blvd Ste 202
Monterey Park, CA 91754-6706
Phone
(213) 483-4500
Fax
(213) 483-4522
NPI assigned
Nov 22, 2006
Last updated
May 8, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NP13432 CA Primary

Addresses

Primary practice location

850 S Atlantic Blvd Ste 202
Monterey Park, CA 91754-6706

Mailing address

850 S Atlantic Blvd Ste 202
Monterey Park, CA 91754-6706
Phone (213) 483-4500

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
I20040811001422 CA Practitioner - Nurse Practitioner 4688646318 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mordo Suchov MD IncGroup PAC ID 8426102112, 15 clinicians

Practice addresses (Care Compare)

850 S Atlantic Blvd
Suite 202
Monterey Park, CA 91754-6706
Phone (213) 483-4500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NP13432CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mordo Suchov MD Inc CurrentSince Apr 8, 2010 Accepting new patients

Locations

16260 Ventura Blvd
Ste LL15
Encino, CA 91436
Phone (818) 582-3427

201 S Alvarado St
Ste 707
Los Angeles, CA 90057
Phone (213) 623-3065

201 S Alvarado St
Ste 711
Los Angeles, CA 90057
Phone (213) 483-4500

850 S Atlantic Blvd
Ste 202
Monterey Park, CA 91754
Phone (213) 483-4500

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1518032762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 S ATLANTIC BLVD STE 202",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917546706",
            "telephone_number": "213-483-4500",
            "fax_number": "213-483-4522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 S ATLANTIC BLVD STE 202",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917546706",
            "telephone_number": "213-483-4500",
            "fax_number": "213-483-4522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RONQUILLO",
        "first_name": "MARIA",
        "middle_name": "D",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-22",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP13432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monterey Park, CA

Sources for this page

Verify at the official NPI Registry.