Provider Demographics
NPI:1043949662
Name:JOFFRE MONACO, CONNIE CARMEN (NP)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:CARMEN
Last Name:JOFFRE MONACO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11031 VIA BRESCIA APT 307
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-1652
Mailing Address - Country:US
Mailing Address - Phone:858-337-9264
Mailing Address - Fax:
Practice Address - Street 1:11031 VIA BRESCIA
Practice Address - Street 2:#307
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129
Practice Address - Country:UM
Practice Address - Phone:858-337-9264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA664444163WH0200X
CA95022078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health