Provider Demographics
NPI:1457600470
Name:MONSALE, SAMUEL FRANTILLA (NP)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:FRANTILLA
Last Name:MONSALE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BRENNER
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-3748
Mailing Address - Country:US
Mailing Address - Phone:510-741-8553
Mailing Address - Fax:925-291-2554
Practice Address - Street 1:3701 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5613
Practice Address - Country:US
Practice Address - Phone:510-752-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16327207RH0003X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology