Provider Demographics
NPI:1114924420
Name:KNOPF-SHAFFER, MONIQUE LOUISE (PA)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LOUISE
Last Name:KNOPF-SHAFFER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MONIQUE
Other - Middle Name:LOUISE
Other - Last Name:KNOPF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:9940 TALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5153
Mailing Address - Country:US
Mailing Address - Phone:714-964-6229
Mailing Address - Fax:
Practice Address - Street 1:47 OBERY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2229
Practice Address - Country:US
Practice Address - Phone:508-747-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2024-01-02
Deactivation Date:2019-07-25
Deactivation Code:
Reactivation Date:2019-08-21
Provider Licenses
StateLicense IDTaxonomies
CAPA11773363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR86538Medicare UPIN