Provider Demographics
NPI:1841630696
Name:PARIPATYADAR, MONISHA SHONA (OD)
Entity type:Individual
Prefix:DR
First Name:MONISHA
Middle Name:SHONA
Last Name:PARIPATYADAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10142 NATIONAL BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3879
Mailing Address - Country:US
Mailing Address - Phone:408-623-7206
Mailing Address - Fax:
Practice Address - Street 1:1760 S PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5902
Practice Address - Country:US
Practice Address - Phone:310-540-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist