Healthcare Provider Details

I. General information

NPI: 1992276877
Provider Name (Legal Business Name): MS. CAROLINE ANN MONCEAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

IV. Provider business mailing address

6612 RABBIT HOLLOW WAY
ELK GROVE CA
95757-8303
US

V. Phone/Fax

Practice location:
  • Phone: 916-688-6246
  • Fax:
Mailing address:
  • Phone: 916-862-4243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: