Basic Information
| Provider Information | |||||||||
| NPI: | 1952550329 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANN | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | JOY SUZANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 W 38TH ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123241086 | ||||||||
| FaxNumber: | 5123241089 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 W 38TH ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123241086 | ||||||||
| FaxNumber: | 5123241089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2008 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25462 | NE | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 18163 | WI | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 60570003 | WA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 25462 | NE | N | Allopathic & Osteopathic Physicians | Hospitalist | 208000000X | Q6228 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.