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NPI Code Detail

MEDICARE: MONICA JOAN TRAIL MD.

MEDICARE: MONICA JOAN TRAIL MD.
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
1207N00000XDermatology PhysicianMD.025872LA
2207N00000XDermatology PhysicianA111384CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619058542
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA JOAN TRAIL MD.
Provider Business Mailing Address
First Line : PO BOX 9602
Second Line :
City : MISSION HILLS
State : CA
Zip : 91346-9602
Country : US
Telephone Number : 818-837-5691
Fax Number : 818-792-4793
Provider Business Practice Location Address
First Line : 19950 RINALDI ST
Second Line :
City : PORTER RANCH
State : CA
Zip : 91326-4141
Country : US
Telephone Number : 818-403-2450
Fax Number : 818-363-9815
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 04/03/2014

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Directions to “ MONICA JOAN TRAIL MD.” Practice Location

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