Provider Demographics
NPI:1043225808
Name:MONZON, MARY FE G (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY FE
Middle Name:G
Last Name:MONZON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7069
Mailing Address - Country:US
Mailing Address - Phone:310-891-3303
Mailing Address - Fax:310-891-3338
Practice Address - Street 1:2543 PACIFIC COAST HWY
Practice Address - Street 2:SUITE F
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-7069
Practice Address - Country:US
Practice Address - Phone:310-891-3303
Practice Address - Fax:310-891-3338
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1870556OtherUNITED CONCORDIA
CAG9250001OtherMEDI-CAL