Provider Demographics
NPI:1215264973
Name:PARKER, MONIQUE DUPREE (LAC , MSOM)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:DUPREE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LAC , MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 COWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618
Mailing Address - Country:US
Mailing Address - Phone:530-304-3195
Mailing Address - Fax:
Practice Address - Street 1:1008 S ST
Practice Address - Street 2:SUITE B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-6553
Practice Address - Country:US
Practice Address - Phone:530-304-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13292171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist