Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A94064 | CA |
N | 208D00000X | General Practice Physician | A94064 | CA |
NPI | 1043432669 |
---|---|
Provider Name | Dr. Monica M. Harms |
First Address | Lake Forest, CA 92630-4891 |
Second Address | Lake Forest, CA 92630-4891 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 28/09/2013 |