Healthcare Provider Details

I. General information

NPI: 1992118293
Provider Name (Legal Business Name): LAQUIA MONIQUE JENKINS CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE JENKINS CMT

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 SUNRISE VISTA DR STE 2180
CITRUS HEIGHTS CA
95610-7057
US

IV. Provider business mailing address

6060 SUNRISE VISTA DR STE 2180
CITRUS HEIGHTS CA
95610-7057
US

V. Phone/Fax

Practice location:
  • Phone: 916-548-6018
  • Fax:
Mailing address:
  • Phone: 916-548-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number15067
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number15067
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15067
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: