Healthcare Provider Details

I. General information

NPI: 1548323058
Provider Name (Legal Business Name): MONICA KIEFFER, D.O., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 2ND ST
ENCINITAS CA
92024-4408
US

IV. Provider business mailing address

842 2ND ST
ENCINITAS CA
92024-4408
US

V. Phone/Fax

Practice location:
  • Phone: 760-436-6882
  • Fax:
Mailing address:
  • Phone: 760-436-6882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A5594
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A5594
License Number StateCA

VIII. Authorized Official

Name: MISS DIANNA C. LAWRENCE
Title or Position: OFFICE MANAGER
Credential:
Phone: 760-436-6882