MEDICARE: MONIQUE PECK

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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1689394835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE PECK

Provider Business Mailing Address
First Line	:	5909 CAHUENGA BLVD APT 3
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-1547
Country	:	US
Telephone Number	:	310-927-0449
Fax Number	:

Provider Business Practice Location Address
First Line	:	5909 CAHUENGA BLVD APT 3
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-1547
Country	:	US
Telephone Number	:	310-927-0449
Fax Number	:

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

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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Directions to “ MONIQUE PECK ” Practice Location

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