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General NPI Number Information
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NPI Number | 1316321912
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Entity Type | Individual
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Provider Name | MONICA ETNIEL O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 52565 CESAR CHAVEZ ST STE 105
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City | COACHELLA
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State | CA
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Zip | 92236-1534
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Country | US
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Telephone | 760-347-6636
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Fax | 844-833-6644
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Provider Business Mailing Address
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Address Line | 15645 ODYSSEY DR
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City | GRANADA HILLS
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State | CA
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Zip | 91344-3276
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Country | US
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Telephone | 818-205-8588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 15345TLG
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License Number State | CA
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