Provider Demographics
NPI:1316433246
Name:DATTA, MONICA B (MS)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:B
Last Name:DATTA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 GILBERT ST APT 116
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4610
Mailing Address - Country:US
Mailing Address - Phone:650-380-5665
Mailing Address - Fax:
Practice Address - Street 1:3505 BROADWAY FL 10
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5714
Practice Address - Country:US
Practice Address - Phone:510-752-2834
Practice Address - Fax:510-752-6754
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001000170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS