Healthcare Provider Details

I. General information

NPI: 1598061665
Provider Name (Legal Business Name): MONIQUE HALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE MANCIA

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 HERNDON AVE
CLOVIS CA
93611-6800
US

IV. Provider business mailing address

2755 HERNDON AVE
CLOVIS CA
93611-6800
US

V. Phone/Fax

Practice location:
  • Phone: 559-970-0958
  • Fax:
Mailing address:
  • Phone: 559-970-0958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number21518
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number112970
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003672A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: