Provider Demographics
NPI:1407984511
Name:EISENBUD, MONIKA M (MD)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:M
Last Name:EISENBUD
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 1:2955 SHATTUCK AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1808
Mailing Address - Country:US
Mailing Address - Phone:510-845-1968
Mailing Address - Fax:
Practice Address - Street 1:2955 SHATTUCK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1808
Practice Address - Country:US
Practice Address - Phone:510-845-1968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG310462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G310460Medicaid
AE2005153OtherDEA FEDERAL
00G310460Medicare ID - Type Unspecified
CA00G310460Medicaid