Healthcare Provider Details

I. General information

NPI: 1063936706
Provider Name (Legal Business Name): CARA MONROE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 09/26/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARTIN LUTHER KING JR. COMMUNITY HOSPITAL 1680 E 120TH STREET
LOS ANGELES CA
90059
US

IV. Provider business mailing address

936 S OLIVE ST APT 309
LOS ANGELES CA
90015-3490
US

V. Phone/Fax

Practice location:
  • Phone: 205-253-4216
  • Fax:
Mailing address:
  • Phone: 205-253-4216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberA175211
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberA175211
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA175211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: