Provider Demographics
NPI:1689661480
Name:GRINBERG, MONICA LILIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:LILIANA
Last Name:GRINBERG
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 1:1025 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3703
Mailing Address - Country:US
Mailing Address - Phone:305-696-0842
Mailing Address - Fax:305-696-2150
Practice Address - Street 1:1025 E 25TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3703
Practice Address - Country:US
Practice Address - Phone:305-696-0842
Practice Address - Fax:305-696-2150
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83797207QA0505X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH70245Medicare UPIN