Provider Demographics
NPI:1124513395
Name:CAMPBELL, MONIQUE ANTOINETTE (RCP)
Entity type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:ANTOINETTE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19406 OPAL LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3243
Mailing Address - Country:US
Mailing Address - Phone:310-213-2237
Mailing Address - Fax:
Practice Address - Street 1:19406 OPAL LN
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-3243
Practice Address - Country:US
Practice Address - Phone:310-213-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305882279P3900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30588OtherRESPIRATORY CARE PRACTITIONER LICENSE
CAB4962549OtherDRIVER LICENSE