Provider Demographics
NPI:1861447336
Name:MONCRIEF, PETRA BEATRICE ROSEMARIE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:PETRA BEATRICE
Middle Name:ROSEMARIE
Last Name:MONCRIEF
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 1:1276 N PALM CANYON DR STE 208
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4430
Mailing Address - Country:US
Mailing Address - Phone:760-325-7776
Mailing Address - Fax:760-406-4015
Practice Address - Street 1:1276 N PALM CANYON DR STE 208
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4430
Practice Address - Country:US
Practice Address - Phone:760-325-7776
Practice Address - Fax:760-406-4015
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8945171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA0089450OtherBLUE SHIELD PIN
CACA0089450OtherBLUE SHIELD PIN