Provider Demographics
NPI:1508008129
Name:SUBOC, MONICA AVERIA (NP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:AVERIA
Last Name:SUBOC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:AVERIA-SUBOC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-865-3948
Mailing Address - Fax:323-865-0061
Practice Address - Street 1:1441 EASTLAKE AVE
Practice Address - Street 2:NOR8302E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0112
Practice Address - Country:US
Practice Address - Phone:323-865-3948
Practice Address - Fax:323-865-0061
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12776363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902846306OtherGROUP NPI
CAW18762OtherGROUP MEDICARE
CAGR0100430OtherGROUP MEDICAL