Monique Justine Wilson, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A143347 Issued in CA

Practice address

15055 Los Gatos Blvd Ste 100
Los Gatos, CA 95032-2056

Phone

(408) 356-1000

Fax

(408) 356-1125

NPI assigned

Jul 11, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Monique Justine Vanaman Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Columbia University College of Physicians and Surgeons, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forefront Dermatology - Pacific, P.C.Group PAC ID 8325946015, 25 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Forefront Dermatology - Pacific, P.C.

  • Dermatology Physician
  • Thousand Oaks, CA
  • NPI 1356535009
  Medicare reassignment Care Compare group NPD
• Forefront Dermatology - Pacific, P.C.

  • Dermatology Physician
  • Upland, CA
  • NPI 1487480448
  NPD
• Forefront Dermatology - Pacific, P.C.

  • Dermatology Physician
  • Los Gatos, CA
  • NPI 1861121741
  NPD
• Carlsbad and Vista Dermatology, Inc.

  • Dermatology Physician
  • Vista, CA
  • NPI 1124328505
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657238400000",
    "number": "1114181914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15055 LOS GATOS BLVD STE 100",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950322056",
            "telephone_number": "408-356-1000",
            "fax_number": "408-356-1125"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15055 Los Gatos Blvd Ste 240",
            "address_purpose": "LOCATION",
            "city": "Los Gatos",
            "state": "CA",
            "postal_code": "950322056",
            "country_code": "US",
            "telephone_number": "408-356-1000",
            "fax_number": "408-356-1125",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15055 Los Gatos Blvd Ste 310",
            "address_purpose": "LOCATION",
            "city": "Los Gatos",
            "state": "CA",
            "postal_code": "950322056",
            "country_code": "US",
            "telephone_number": "408-356-1119",
            "fax_number": "408-356-1125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MONIQUE",
        "middle_name": "JUSTINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-11",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A143347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MONIQUE",
            "last_name": "VANAMAN",
            "middle_name": "JUSTINE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hailey Williford, LCSW
• Lara Jeanne Willing, B.A.
• Willow Anxiety and Ocd
• Holly Madeleine Wilson, LMFT
• Lisa Wilson
• Solomon Wilson
• Susan Wilturner, MD
• With Therapy Associates
• Barbara Witney, M.A.
• Jerry Wojsiat, D.C.

• Dermatology Physician in Los Gatos, CA
• Providers in Los Gatos, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.