Individual
MS. LILLIAN GRAY MGONJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
623 S. LONG BEACH BLVD, SUITE A/B, COMPTON, CA 90221
(310) 637-0341
(310) 637-0341
Mailing address
623 S. LONG BEACH BLVD, SUITE A & B, LONG BEACH, CA 90221
(562) 233-7970
(562) 283-1000
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
581333
CA
163WA2000X
Administrator Registered Nurse
Primary
581433
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
581433
RN LICENSE
CA
Enumeration date
09/14/2009
Last updated
09/14/2009
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