Healthcare Provider Details

I. General information

NPI: 1063785426
Provider Name (Legal Business Name): MONICA GARDNER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LA CASA VIA STE 208
WALNUT CREEK CA
94598-3007
US

IV. Provider business mailing address

120 LA CASA VIA STE 208
WALNUT CREEK CA
94598-3007
US

V. Phone/Fax

Practice location:
  • Phone: 925-935-5356
  • Fax: 925-935-1070
Mailing address:
  • Phone: 925-935-5356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: