Provider Demographics
NPI:1891783148
Name:MONAHAN, PATRICK MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:MONAHAN
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 1:3395 S BASCOM AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-6770
Mailing Address - Country:US
Mailing Address - Phone:408-559-0666
Mailing Address - Fax:408-377-0811
Practice Address - Street 1:3803 S BASCOM AVE
Practice Address - Street 2:STE 104
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7317
Practice Address - Country:US
Practice Address - Phone:408-559-0666
Practice Address - Fax:408-377-0811
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G607230Medicaid
CA00G607230Medicare ID - Type Unspecified
CA00G607230Medicaid