Provider Demographics
NPI:1093595233
Name:MONCADA-ROMAN, CIANNA
Entity Type:Individual
Prefix:
First Name:CIANNA
Middle Name:
Last Name:MONCADA-ROMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 LA PURISSIMA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-2835
Mailing Address - Country:US
Mailing Address - Phone:916-300-3338
Mailing Address - Fax:
Practice Address - Street 1:426 LA PURISSIMA WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-2835
Practice Address - Country:US
Practice Address - Phone:916-300-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health