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General NPI Number Information
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NPI Number | 1932766383
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Entity Type | Individual
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Provider Name | MONIQUE S CANADA PA
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Gender | Female
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 2433 MARCONI AVE
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City | SACRAMENTO
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State | CA
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Zip | 95821-4807
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Country | US
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Telephone | 916-737-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 506 LIBERTY CROSSING CT
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City | SAINT PETERS
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State | MO
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Zip | 63376-4448
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PA59711
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA59711
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License Number State | CA
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