Provider Demographics
NPI:1386469062
Name:NOVAL, MONALISA
Entity type:Individual
Prefix:MRS
First Name:MONALISA
Middle Name:
Last Name:NOVAL
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 1:1243 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9594
Mailing Address - Country:US
Mailing Address - Phone:209-244-8785
Mailing Address - Fax:
Practice Address - Street 1:1243 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9594
Practice Address - Country:US
Practice Address - Phone:209-244-8785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA721854163W00000X
CA21998363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner