Individual
MISS MONICA TIRTARAHARDJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5503 S CONGRESS AVE STE 204, LAKE WORTH, FL 33462-6626
(561) 410-5110
Mailing address
5503 S CONGRESS AVE STE 204, ATLANTIS, FL 33462-6626
(561) 410-5110
(561) 328-3911
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9112886
FL
Other
Enumeration date
02/27/2020
Last updated
07/12/2020
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