Provider Demographics
NPI:1720406192
Name:MONSALUD, THERESA MARIE
Entity Type:Individual
Prefix:
First Name:THERESA MARIE
Middle Name:
Last Name:MONSALUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 ENCINITAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2844
Mailing Address - Country:US
Mailing Address - Phone:760-942-2018
Mailing Address - Fax:760-942-2664
Practice Address - Street 1:1320 ENCINITAS BLVD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2844
Practice Address - Country:US
Practice Address - Phone:760-942-2018
Practice Address - Fax:760-942-2664
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60347470183500000X
CARPH70676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist