Provider Demographics
NPI:1013116052
Name:GEDA, MONINA ILANO (DO)
Entity Type:Individual
Prefix:DR
First Name:MONINA
Middle Name:ILANO
Last Name:GEDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1909 BEACH BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2643
Mailing Address - Country:US
Mailing Address - Phone:904-246-2752
Mailing Address - Fax:904-246-2758
Practice Address - Street 1:1909 BEACH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-2643
Practice Address - Country:US
Practice Address - Phone:904-246-2752
Practice Address - Fax:904-246-2758
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12954207Q00000X
CA20A10419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine