Healthcare Provider Details

I. General information

NPI: 1922022755
Provider Name (Legal Business Name): MONICA ANN KIEFFER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
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 SECOND STREET
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 TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A5594
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A5594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: