Provider Demographics
NPI:1912404492
Name:FEDEROFF, MONICA CORY (MD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:CORY
Last Name:FEDEROFF
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9187 CLAIREMONT MESA BLVD STE 6-540
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1257
Mailing Address - Country:US
Mailing Address - Phone:619-894-7380
Mailing Address - Fax:
Practice Address - Street 1:143 N LARCHMONT BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3704
Practice Address - Country:US
Practice Address - Phone:424-484-5757
Practice Address - Fax:424-732-5490
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2024-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1646772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437970712OtherGROUP NPI