Provider Demographics
NPI:1619973666
Name:MONAHAN, CAROLYN O (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:O
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:215 S HICKORY ST
Mailing Address - Street 2:STE 126
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3439
Mailing Address - Country:US
Mailing Address - Phone:760-745-7313
Mailing Address - Fax:760-745-6360
Practice Address - Street 1:215 S HICKORY ST
Practice Address - Street 2:STE 126
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4359
Practice Address - Country:US
Practice Address - Phone:760-745-7313
Practice Address - Fax:760-745-6360
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2011-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG26892208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43134Medicare UPIN