Provider Demographics
NPI:1578593471
Name:TANTRAPHOL, MONICA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:TANTRAPHOL
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 1:2501 PULLMAN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5511
Mailing Address - Country:US
Mailing Address - Phone:949-437-9063
Mailing Address - Fax:949-437-9069
Practice Address - Street 1:29472 AVE DE LAS BANDERAS
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2651
Practice Address - Country:US
Practice Address - Phone:949-459-9968
Practice Address - Fax:949-766-2565
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine