Provider Demographics
NPI:1467898536
Name:MONCADA, JOEL DE VERA (LAC)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:DE VERA
Last Name:MONCADA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 HOSPITAL DR
Mailing Address - Street 2:SUITE #203A
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2500
Mailing Address - Country:US
Mailing Address - Phone:707-563-9010
Mailing Address - Fax:
Practice Address - Street 1:127 HOSPITAL DR
Practice Address - Street 2:SUITE #203A
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589
Practice Address - Country:US
Practice Address - Phone:707-563-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15274171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist