=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518957539
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW G. MONROY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2005
-----------------------------------------------------
Last Update Date | 01/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 S HALCYON RD SUITE 106
-----------------------------------------------------
City | ARROYO GRANDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93420-3872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-473-3705
-----------------------------------------------------
Fax | 805-473-4832
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 160
-----------------------------------------------------
City | ARROYO GRANDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93421-0160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-473-3705
-----------------------------------------------------
Fax | 805-473-4832
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | A69536
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------