Provider Demographics
NPI:1366849416
Name:LUXENBURG, MONIQUE KYM (DPM)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:KYM
Last Name:LUXENBURG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:KYM
Other - Last Name:TERRAZAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:9663 SANTA MONICA BLVD # 1151
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 N ROBERTSON BLVD STE 106A
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1767
Practice Address - Country:US
Practice Address - Phone:818-922-2244
Practice Address - Fax:877-239-0994
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5301213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty