Provider Demographics
NPI:1265487383
Name:MONIGATTI LAKE, NEVA MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:NEVA
Middle Name:MARIE
Last Name:MONIGATTI LAKE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:300 SIERRA COLLEGE DR
Mailing Address - Street 2:STE 170
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5083
Mailing Address - Country:US
Mailing Address - Phone:530-273-4376
Mailing Address - Fax:530-273-6426
Practice Address - Street 1:300 SIERRA COLLEGE DR
Practice Address - Street 2:STE 170
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5083
Practice Address - Country:US
Practice Address - Phone:530-273-4376
Practice Address - Fax:530-273-6426
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2013-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG58310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA080061188OtherRAILROAD MEDICARE
CAZZZ627762OtherBLUE SHIELD
CA00G583100Medicaid
CA00G583100Medicaid