Provider Demographics
NPI:1124823935
Name:MONCADA, DIVA FAY
Entity type:Individual
Prefix:
First Name:DIVA
Middle Name:FAY
Last Name:MONCADA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16210 W 9 MILE RD APT 403
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5918
Mailing Address - Country:US
Mailing Address - Phone:262-488-4169
Mailing Address - Fax:
Practice Address - Street 1:16210 W 9 MILE RD APT 403
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5918
Practice Address - Country:US
Practice Address - Phone:262-488-4169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program