Provider Demographics
NPI:1205334687
Name:HAAS, MONICA SOOBY (CSA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:SOOBY
Last Name:HAAS
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:RENEE
Other - Last Name:SOOBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7934 VISHAL DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2176
Mailing Address - Country:US
Mailing Address - Phone:210-324-2550
Mailing Address - Fax:
Practice Address - Street 1:7934 VISHAL DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2176
Practice Address - Country:US
Practice Address - Phone:210-324-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0136000290246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
4340OtherNSAA