Provider Demographics
NPI:1912404492
Name:FEDEROFF, MONICA CORY (PHD, MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:CORY
Last Name:FEDEROFF
Suffix:
Gender:F
Credentials:PHD, MD
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9500 GILMAN DR # 851
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-5004
Mailing Address - Country:US
Mailing Address - Phone:619-543-0259
Mailing Address - Fax:619-543-7013
Practice Address - Street 1:DEPARTMENT OF PSYCHIATRY UCSD 9500 GILMAN DRIVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-4131
Practice Address - Country:US
Practice Address - Phone:619-543-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1646772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry