MEDICARE: JENAE MONASTERIAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1578174116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENAE MONASTERIAL

Provider Business Mailing Address
First Line	:	1722 CLEMENS RD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-1802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1722 CLEMENS RD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-1802
Country	:	US
Telephone Number	:	510-557-5360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2020
Last Update Date	:	08/16/2020

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Directions to “ JENAE MONASTERIAL ” Practice Location

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