Provider Demographics
NPI:1841905361
Name:MATHENGE, MONICA MUTHONI
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:MUTHONI
Last Name:MATHENGE
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 1:4800 MARCONI AVE APT 1464800
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4111
Mailing Address - Country:US
Mailing Address - Phone:916-349-6324
Mailing Address - Fax:
Practice Address - Street 1:4800 MARCONI AVE APT 146
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4160
Practice Address - Country:US
Practice Address - Phone:916-349-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238344164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty