Provider Demographics
NPI:1720307424
Name:MONFIERO, KENNEDY MESA
Entity Type:Individual
Prefix:MR
First Name:KENNEDY
Middle Name:MESA
Last Name:MONFIERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 W CARSON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3172
Mailing Address - Country:US
Mailing Address - Phone:310-618-1940
Mailing Address - Fax:310-618-1900
Practice Address - Street 1:2400 W CARSON ST STE 210
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3172
Practice Address - Country:US
Practice Address - Phone:310-618-1940
Practice Address - Fax:310-618-1900
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider