Provider Demographics
NPI:1396090379
Name:WAIDMANN, MONICA (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:WAIDMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:SU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1000 NEWBURY RD 115
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6436
Mailing Address - Country:US
Mailing Address - Phone:805-955-9990
Mailing Address - Fax:805-955-9966
Practice Address - Street 1:1000 NEWBURY RD 115
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6436
Practice Address - Country:US
Practice Address - Phone:805-375-1611
Practice Address - Fax:805-375-1655
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134489174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist