Provider Demographics
NPI:1659383099
Name:MONACO, SEAN (PA)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:MONACO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5417 PACIFIC BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-2532
Mailing Address - Country:US
Mailing Address - Phone:323-923-4160
Mailing Address - Fax:323-923-4169
Practice Address - Street 1:5417 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2532
Practice Address - Country:US
Practice Address - Phone:323-923-4160
Practice Address - Fax:323-923-4169
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA14957Medicaid