Basic Information
| Provider Information | |||||||||
| NPI: | 1790704161 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONROY | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 WEST BUNNY AVENUE | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934582805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057864111 | ||||||||
| FaxNumber: | 8055436357 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 CASA STREET | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934051890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057864111 | ||||||||
| FaxNumber: | 8055436357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 10/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A73037 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | GR0092203 | 05 | CA | MEDICAID | CB217791 | 01 | CA | MEDICARE ID | OTHER |