Provider Demographics
NPI:1306845946
Name:HARRISON-MONGE-REINER, JUDITH A (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:HARRISON-MONGE-REINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10050
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90267-7550
Mailing Address - Country:US
Mailing Address - Phone:310-335-4956
Mailing Address - Fax:310-335-4098
Practice Address - Street 1:16100 SAND CANYON AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92867
Practice Address - Country:US
Practice Address - Phone:949-417-1100
Practice Address - Fax:949-417-1165
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA231912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A231910Medicaid
CAWA23191GMedicare PIN
WA23191AMedicare PIN
A86640Medicare UPIN
CA00A231910Medicaid