Basic Information
| Provider Information | |||||||||
| NPI: | 1205276847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DYBAS | ||||||||
| FirstName: | MONICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3267 BOULDER AVE | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936372654 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 23370 ROAD 22 | ||||||||
| Address2: | |||||||||
| City: | CHOWCHILLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936108504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596655531 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2013 | ||||||||
| LastUpdateDate: | 06/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 47340 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.