Provider Demographics
NPI:1619058542
Name:TRAIL, MONICA JOAN (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:JOAN
Last Name:TRAIL
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:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5691
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:19950 RINALDI ST
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4141
Practice Address - Country:US
Practice Address - Phone:818-403-2450
Practice Address - Fax:818-363-9815
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.025872207N00000X
CAA111384207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1048208Medicaid
CA00A1113840Medicaid
LA1048208Medicaid
I64690Medicare UPIN
CA00A1113840Medicaid