Provider Demographics
NPI:1285876615
Name:MONICA P CEPIN, MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:MONICA P CEPIN, MD A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CEPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-427-0665
Mailing Address - Street 1:333 H STREET
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4410
Mailing Address - Country:US
Mailing Address - Phone:619-427-0665
Mailing Address - Fax:619-427-3366
Practice Address - Street 1:333 H ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5555
Practice Address - Country:US
Practice Address - Phone:619-427-0665
Practice Address - Fax:619-427-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56350208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA56350Medicare PIN