Healthcare Provider Details

I. General information

NPI: 1003399981
Provider Name (Legal Business Name): MONIKA CIESZYNSKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 12/21/2019
Certification Date: 12/21/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 MISSION AVE STE A
CARMICHAEL CA
95608-2955
US

IV. Provider business mailing address

1717 ROSLYN RD
ROSELLE IL
60172-4904
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-9000
  • Fax: 916-971-9010
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.006694
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number56590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: