Provider Demographics
NPI:1710001920
Name:MONIHAN, JUDY LOUISE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LOUISE
Last Name:MONIHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95064-1077
Mailing Address - Country:US
Mailing Address - Phone:831-426-0810
Mailing Address - Fax:
Practice Address - Street 1:1156 HIGH ST
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA SANTA CRUZ STUDENT HEALTH
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95064-1077
Practice Address - Country:US
Practice Address - Phone:831-459-2869
Practice Address - Fax:831-459-3546
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 12982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine