Healthcare Provider Details

I. General information

NPI: 1366756298
Provider Name (Legal Business Name): MONICA LYS TEIXIDO RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 5TH ST
SANTA ROSA CA
95404-4428
US

IV. Provider business mailing address

625 5TH ST
SANTA ROSA CA
95404-4428
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN315406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: