Healthcare Provider Details

I. General information

NPI: 1790107670
Provider Name (Legal Business Name): TEV MONNIN MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 18TH ST
OAKLAND CA
94606-2414
US

IV. Provider business mailing address

520 E 18TH ST
OAKLAND CA
94606-2414
US

V. Phone/Fax

Practice location:
  • Phone: 774-240-3403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000284
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number812590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: