Provider Demographics
NPI:1366849416
Name:LUXENBURG, MONIQUE KYM (DPM)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:KYM
Last Name:LUXENBURG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:KYM
Other - Last Name:TERRAZAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:9663 SANTA MONICA BLVD # 1151
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7711 W RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5553
Practice Address - Country:US
Practice Address - Phone:440-885-1000
Practice Address - Fax:440-255-9400
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003974213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty