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General NPI Number Information
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NPI Number | 1437970712
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Entity Type | Organization
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Legal Business Name | MONICA FEDEROFF MD PHD INC
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 143 N LARCHMONT BLVD FL 2
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City | LOS ANGELES
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State | CA
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Zip | 90004-3704
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Country | US
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Telephone | 424-484-5757
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Fax | 424-732-5490
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Provider Business Mailing Address
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Address Line | 5254 FINO DR
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City | SAN DIEGO
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State | CA
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Zip | 92124-2014
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Country | US
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Telephone | 585-329-8393
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MONICA CORY FEDEROFF
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Credential | MD
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Telephone | 585-329-8393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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