Provider Demographics
NPI:1316321912
Name:ETNIEL, MONICA (OD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:ETNIEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:YOUCEFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:15645 ODYSSEY DR
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-3276
Mailing Address - Country:US
Mailing Address - Phone:818-205-8588
Mailing Address - Fax:
Practice Address - Street 1:52565 CESAR CHAVEZ ST STE 105
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1534
Practice Address - Country:US
Practice Address - Phone:760-347-6636
Practice Address - Fax:844-833-6644
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15345TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist