Healthcare Provider Details

I. General information

NPI: 1366849416
Provider Name (Legal Business Name): MONIQUE KYM LUXENBURG DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE KYM TERRAZAS DPM

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 W RIDGEWOOD DR
PARMA OH
44129-5553
US

IV. Provider business mailing address

9663 SANTA MONICA BLVD # 1151
BEVERLY HILLS CA
90210-4303
US

V. Phone/Fax

Practice location:
  • Phone: 440-885-1000
  • Fax: 440-255-9400
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.003974
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.003974
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: