Provider Demographics
NPI:1780616201
Name:DO VALLE, MONIKA FERREIRA QUEIROZ (DO)
Entity type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:FERREIRA QUEIROZ
Last Name:DO VALLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 CHANNING WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2606
Mailing Address - Country:US
Mailing Address - Phone:415-322-8834
Mailing Address - Fax:
Practice Address - Street 1:268 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2606
Practice Address - Country:US
Practice Address - Phone:415-322-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A113222084P0800X
MA2284152084P0800X
HIDOS-2271-02084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry