Lillian Gray Mgonja, REGISTERED NURSE

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

581433 Issued in CA

Practice address

623 S. Long Beach Blvd
Suite a/B
Compton, CA 90221

Phone

(310) 637-0341

Fax

(310) 637-0341

NPI assigned

Sep 14, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Miss Lillian John Mmari Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252886400000",
    "number": "1851624571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 S. LONG BEACH BLVD",
            "address_2": "SUITE A & B",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "90221",
            "telephone_number": "562-233-7970",
            "fax_number": "562-283-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 S. LONG BEACH BLVD",
            "address_2": "SUITE A/B",
            "city": "COMPTON",
            "state": "CA",
            "postal_code": "90221",
            "telephone_number": "310-637-0341",
            "fax_number": "310-637-0341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MGONJA",
        "first_name": "LILLIAN",
        "middle_name": "GRAY",
        "name_prefix": "Ms.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-14",
        "last_updated": "2009-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "581333",
            "primary": false
        },
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "CA",
            "license": "581433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "581433",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERD NURSE",
            "identifier": "581433",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LILLIAN",
            "last_name": "MMARI",
            "middle_name": "JOHN",
            "prefix": "MISS",
            "credential": "RN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Mercy Medical Supplies, Inc.
• Pamela Sue Merino, M. S.
• Ronneika Latonya Merrill
• Jay H Messinger, OD
• Briana Meza
• MH Counseling, Inc. Licensed Clinical Social Worker
• Michael Vincent Laureola DDS Inc
• Nesreen Samy Michael
• Venus Miles
• Jacqueline Creque Miller, MSW

• Administrator Registered Nurse in Compton, CA
• Providers in Compton, CA by specialty
• Administrator Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2009; 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.