MEDICARE: DR. SHERYL MONAUGHAN PHD, A PSYCHOLOGICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1437453701	OTHER	CA	NPI

General Provider Information

NPI Number	:	1376813980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SHERYL MONAUGHAN PHD, A PSYCHOLOGICAL CORPORATION

Provider Business Mailing Address
First Line	:	10736 JEFFERSON BLVD
Second Line	:	505
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4933
Country	:	US
Telephone Number	:	310-313-0999
Fax Number	:

Provider Business Practice Location Address
First Line	:	10940 WILSHIRE BLVD
Second Line	:	600
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3915
Country	:	US
Telephone Number	:	310-313-0999
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. SHERYL MONAUGHAN
Credential	:	PHD
Telephone Number	:	310-313-0999

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	03/26/2012

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