Provider Demographics
NPI:1003070061
Name:MONIS, GRACE FORTES (MD, PHD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:FORTES
Last Name:MONIS
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:DIVINA GRACE
Other - Middle Name:FORTES
Other - Last Name:MONIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4400 V ST
Mailing Address - Street 2:UC DAVIS MEDICAL CENTER, PATHOLOGY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1445
Mailing Address - Country:US
Mailing Address - Phone:916-734-7347
Mailing Address - Fax:
Practice Address - Street 1:4400 V ST
Practice Address - Street 2:UC DAVIS MEDICAL CENTER, PATHOLOGY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1445
Practice Address - Country:US
Practice Address - Phone:916-734-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134462207ZP0105X, 207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine