Healthcare Provider Details

I. General information

NPI: 1114350055
Provider Name (Legal Business Name): MS. MONICA GEORGINA MENJIVAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 NAPA VALLEY CORPORATE DR BLDG A
NAPA CA
94558-6216
US

IV. Provider business mailing address

2751 NAPA VALLEY CORPORATE DR BLDG A
NAPA CA
94558-6216
US

V. Phone/Fax

Practice location:
  • Phone: 707-299-1482
  • Fax: 707-259-8721
Mailing address:
  • Phone: 707-299-1482
  • Fax: 707-259-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW69581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: