Provider Demographics
NPI:1477688612
Name:AMANTIA, MONICA RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:RENE
Last Name:AMANTIA
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 1:4230 WHITSETT AVE UNIT 4
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1651
Mailing Address - Country:US
Mailing Address - Phone:310-592-9012
Mailing Address - Fax:
Practice Address - Street 1:11271 VENTURA BLVD
Practice Address - Street 2:#470
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3136
Practice Address - Country:US
Practice Address - Phone:310-592-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA892302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology