Provider Demographics
NPI:1326056466
Name:MARTIN-ROBERTS, MONIFA TAMU (PA)
Entity Type:Individual
Prefix:MRS
First Name:MONIFA
Middle Name:TAMU
Last Name:MARTIN-ROBERTS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 S MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-6126
Mailing Address - Country:US
Mailing Address - Phone:909-988-9651
Mailing Address - Fax:
Practice Address - Street 1:9350 FLAIR DR STE 102
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2828
Practice Address - Country:US
Practice Address - Phone:626-407-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17207363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant