Provider Demographics
NPI:1225495161
Name:CADILLO, MONIQUE YVONNE
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:YVONNE
Last Name:CADILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11136 LEMAY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2009
Mailing Address - Country:US
Mailing Address - Phone:323-559-1173
Mailing Address - Fax:
Practice Address - Street 1:3580 WILSHIRE BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2501
Practice Address - Country:US
Practice Address - Phone:323-559-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator