Provider Demographics
NPI:1689663767
Name:MONDRAGON, ALLISON SMALLEY (FNP C MSN)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:SMALLEY
Last Name:MONDRAGON
Suffix:
Gender:F
Credentials:FNP C MSN
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9914 W LILAC RD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-5301
Mailing Address - Country:US
Mailing Address - Phone:909-273-9111
Mailing Address - Fax:
Practice Address - Street 1:9914 W LILAC RD
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-5301
Practice Address - Country:US
Practice Address - Phone:909-273-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner