Provider Demographics
NPI:1821472127
Name:NEAL, KANISHA MONAE
Entity Type:Individual
Prefix:MS
First Name:KANISHA
Middle Name:MONAE
Last Name:NEAL
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 1:27925 ROCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5730
Mailing Address - Country:US
Mailing Address - Phone:951-581-4818
Mailing Address - Fax:951-485-9459
Practice Address - Street 1:27925 ROCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-5730
Practice Address - Country:US
Practice Address - Phone:951-581-4818
Practice Address - Fax:951-485-9459
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No374J00000XNursing Service Related ProvidersDoula