Provider Demographics
NPI:1790855609
Name:KADERALI, MONICA BLOCH (LAC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:BLOCH
Last Name:KADERALI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 CALABRIA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4536
Mailing Address - Country:US
Mailing Address - Phone:805-708-2791
Mailing Address - Fax:
Practice Address - Street 1:5266 HOLLISTER AVE
Practice Address - Street 2:BUILDING B, SUITE 209
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2037
Practice Address - Country:US
Practice Address - Phone:805-708-2791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10244171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist