Provider Demographics
NPI:1457376816
Name:MONACO, RENATO PASCUALE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENATO
Middle Name:PASCUALE
Last Name:MONACO
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 1:1506 LINCOLN LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4938
Mailing Address - Country:US
Mailing Address - Phone:949-642-2233
Mailing Address - Fax:949-574-7135
Practice Address - Street 1:1506 LINCOLN LANE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-4938
Practice Address - Country:US
Practice Address - Phone:949-642-2233
Practice Address - Fax:949-574-7135
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC18379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC18379OtherSTATE LICENSE NUMBER
CAC18379Medicare UPIN