Provider Demographics
NPI:1548554611
Name:VICTOR C MONEKE MD INC
Entity type:Organization
Organization Name:VICTOR C MONEKE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-946-1592
Mailing Address - Street 1:15995 TUSCOLA RD STE 208
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2159
Mailing Address - Country:US
Mailing Address - Phone:760-946-1592
Mailing Address - Fax:760-946-1949
Practice Address - Street 1:15995 TUSCOLA RD STE 208
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2159
Practice Address - Country:US
Practice Address - Phone:760-946-1592
Practice Address - Fax:760-946-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51551207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG04959Medicare UPIN