Provider Demographics
NPI:1629572904
Name:KUMAR, MONICA PRAVEENA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:PRAVEENA
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MONICA
Other - Middle Name:PRAVEENA
Other - Last Name:IRUTHIA KUMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1100 W TEHACHAPI BLVD
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-2563
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-869-1503
Practice Address - Street 1:CLINICA SIERRA VISTA/EAST NILES COMMUNITY HEALTH CENTER
Practice Address - Street 2:7800 NILES STREET
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4937
Practice Address - Country:US
Practice Address - Phone:661-328-4284
Practice Address - Fax:661-616-9977
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL154390200000X
CAA173428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine