Provider Demographics
NPI:1477597904
Name:MONACO, WINIFRED LEAH (DC)
Entity Type:Individual
Prefix:DR
First Name:WINIFRED
Middle Name:LEAH
Last Name:MONACO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-4641
Mailing Address - Country:US
Mailing Address - Phone:949-631-5226
Mailing Address - Fax:949-631-8538
Practice Address - Street 1:2664 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4641
Practice Address - Country:US
Practice Address - Phone:949-631-5226
Practice Address - Fax:949-631-8538
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26779Medicare ID - Type UnspecifiedCHIROPRACTIC LICENSE #
CAV05614Medicare UPIN