Provider Demographics
NPI:1154463743
Name:MONRAZ, SERGIO AQUILES (DDS)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:AQUILES
Last Name:MONRAZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SERGIO
Other - Middle Name:AQUILES
Other - Last Name:MONRAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:916 TURNBERRY CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-7991
Mailing Address - Country:US
Mailing Address - Phone:707-838-0444
Mailing Address - Fax:707-838-4482
Practice Address - Street 1:173 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7435
Practice Address - Country:US
Practice Address - Phone:707-838-0444
Practice Address - Fax:707-838-4482
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4068301OtherMEDI-CAL
CAB40683OtherDELTA HEALTHY FAMILIES