Provider Demographics
NPI:1376241216
Name:SMALL, MONIQUE MARIA
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:MARIA
Last Name:SMALL
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 1:1765 CALAIS DR APT 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3541
Mailing Address - Country:US
Mailing Address - Phone:215-801-1934
Mailing Address - Fax:
Practice Address - Street 1:1765 CALAIS DR APT 2
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3541
Practice Address - Country:US
Practice Address - Phone:215-801-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health