MEDICARE: DR. MONIKA A. GOTTLIEB M.D.

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	207R00000X	Internal Medicine Physician	MD00037805	WA
2	208M00000X	Hospitalist Physician	M10447	ID
3	208M00000X	Hospitalist Physician	MD00037805	WA
4	207R00000X	Internal Medicine Physician	166839	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00351556	OTHER	NC	RR MCARE

General Provider Information

NPI Number	:	1750333217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONIKA A. GOTTLIEB M.D.

Provider Business Mailing Address
First Line	:	2671 MAPLE AVE
Second Line	:
City	:	MORRO BAY
State	:	CA
Zip	:	93442-1725
Country	:	US
Telephone Number	:	805-242-1141
Fax Number	:	805-254-0408

Provider Business Practice Location Address
First Line	:	2671 MAPLE AVE
Second Line	:
City	:	MORRO BAY
State	:	CA
Zip	:	93442-1725
Country	:	US
Telephone Number	:	805-242-1141
Fax Number	:	805-254-0408

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	06/05/2020

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Directions to “ DR. MONIKA A. GOTTLIEB M.D.” Practice Location

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