Provider Demographics
NPI:1548323058
Name:MONICA KIEFFER, D.O., INC.
Entity type:Organization
Organization Name:MONICA KIEFFER, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-436-6882
Mailing Address - Street 1:842 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4408
Mailing Address - Country:US
Mailing Address - Phone:760-436-6882
Mailing Address - Fax:
Practice Address - Street 1:842 2ND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4408
Practice Address - Country:US
Practice Address - Phone:760-436-6882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5594208D00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE17535-Medicare UPIN
CAW20426Medicare PIN
CA20A5594Medicare ID - Type Unspecified