Provider Demographics
NPI:1023197894
Name:FARIAS, MONICA S (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:S
Last Name:FARIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:3900 BOAT CLUB RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3201
Practice Address - Country:US
Practice Address - Phone:817-237-7161
Practice Address - Fax:817-237-0966
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4054208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX444061OtherPHCS PIN
TX1640377OtherFIRSTHEALTH PIN
TX6730003OtherCIGNA PIN
TX110730205OtherCSHCN
TX148130100OtherFIRSTCARE PIN
TX89X982OtherBCBSTX IND PIN
TX00U87ZOtherBCBSTX GRP PIN
1750369203OtherGRP NPI NUMBER
TX1761917OtherUHC PIN
TX110730204Medicaid
TX5847574OtherAETNA PIN
TXFARMG58937OtherCCHIP PIN
TXFARMG58937OtherCCHIP PIN
TX89X982OtherBCBSTX IND PIN