Provider Demographics
NPI:1881972081
Name:REEVES, MONICA MARCEL (IDC)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:MARCEL
Last Name:REEVES
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3177 CHATELAIN PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2041
Mailing Address - Country:US
Mailing Address - Phone:850-512-9649
Mailing Address - Fax:
Practice Address - Street 1:3177 CHATELAIN PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2041
Practice Address - Country:US
Practice Address - Phone:850-512-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman