Healthcare Provider Details

I. General information

NPI: 1326056466
Provider Name (Legal Business Name): MONIFA TAMU MARTIN-ROBERTS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9350 FLAIR DR STE 102
EL MONTE CA
91731-2828
US

IV. Provider business mailing address

2118 S MOUNTAIN AVE
ONTARIO CA
91762-6126
US

V. Phone/Fax

Practice location:
  • Phone: 626-407-0300
  • Fax:
Mailing address:
  • Phone: 909-988-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: