Healthcare Provider Details

I. General information

NPI: 1932766383
Provider Name (Legal Business Name): MONIQUE S CANADA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 MARCONI AVE
SACRAMENTO CA
95821-4807
US

IV. Provider business mailing address

506 LIBERTY CROSSING CT
SAINT PETERS MO
63376-4448
US

V. Phone/Fax

Practice location:
  • Phone: 916-737-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA59711
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPA59711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: