Provider Demographics
NPI:1952550329
Name:MANN, MONICA JOY SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:JOY SUZANNE
Last Name:MANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1006
Mailing Address - Country:US
Mailing Address - Phone:512-324-1086
Mailing Address - Fax:512-324-1089
Practice Address - Street 1:1201 W 38TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1006
Practice Address - Country:US
Practice Address - Phone:512-324-1086
Practice Address - Fax:512-324-1089
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25462208000000X, 208M00000X
WI18163208000000X
WA60570003208M00000X
TXQ6228208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist