MEDICARE: MONET XMINIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1467094912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONET XMINIS

Provider Business Mailing Address
First Line	:	4690 NW 41ST PL
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-4781
Country	:	US
Telephone Number	:	965-607-0622
Fax Number	:

Provider Business Practice Location Address
First Line	:	4690 NW 41ST PL
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-4781
Country	:	US
Telephone Number	:	954-607-0622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	10/16/2019

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Directions to “ MONET XMINIS ” Practice Location

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