Provider Demographics
NPI:1356668735
Name:CHOCK, MONIKA KIMBERLY
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:KIMBERLY
Last Name:CHOCK
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 1:101 WILSON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7834
Mailing Address - Country:US
Mailing Address - Phone:650-714-8622
Mailing Address - Fax:
Practice Address - Street 1:101 WILSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7834
Practice Address - Country:US
Practice Address - Phone:831-648-8005
Practice Address - Fax:831-648-7376
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 117774207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology