Basic Information
| Provider Information | |||||||||
| NPI: | 1407502149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANTY | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | |||||||||
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| Credential: | VN254227 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1751 RED ALDER AVE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958342477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624506514 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6127 FAIR OAKS BLVD | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956084818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169748990 | ||||||||
| FaxNumber: | 9169747851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2022 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN254227 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.