Provider Demographics
NPI:1609964360
Name:MONIUSZKO, ANITA CAROLINE (DPM)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:CAROLINE
Last Name:MONIUSZKO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 POPPY AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2508
Mailing Address - Country:US
Mailing Address - Phone:949-706-7463
Mailing Address - Fax:
Practice Address - Street 1:430 POPPY AVE
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2508
Practice Address - Country:US
Practice Address - Phone:949-706-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4485213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAER570AMedicare UPIN