Individual
MONICA MICON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G50225
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G502250
BLUE SHIELD OF CA
—
05
—
00G502250
—
CA
01
—
050396CE93257
TRAILBLAZER
—
01
—
300129072
RAILROAD MEDICARE
—
Enumeration date
07/18/2005
Last updated
08/18/2008
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