Provider Demographics
NPI:1740435940
Name:MONAHAN, AMANDA ANN MODJESKI (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ANN MODJESKI
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:ANN R
Other - Last Name:MODJESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:858-249-6749
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR # MC8812
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1911
Practice Address - Country:US
Practice Address - Phone:858-657-7072
Practice Address - Fax:858-657-7035
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115693207L00000X, 207L00000X, 390200000X
MA232327390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology