Provider Demographics
NPI:1851348122
Name:MCMONIGLE, E. MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:E. MICHAEL
Middle Name:
Last Name:MCMONIGLE
Suffix:
Gender:M
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:DEPT LA 21577
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1577
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:949-263-1639
Practice Address - Street 1:2131 W 3RD ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1901
Practice Address - Country:US
Practice Address - Phone:213-484-7901
Practice Address - Fax:213-353-0325
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG233802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G233800OtherBLUE SHIELD
CA00G233800Medicaid
CAWG23380BMedicare PIN
CA00G233800Medicaid
A89577Medicare UPIN