Provider Demographics
NPI:1992118293
Name:JENKINS, LAQUIA MONIQUE (CMT)
Entity type:Individual
Prefix:MISS
First Name:LAQUIA
Middle Name:MONIQUE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:6060 SUNRISE VISTA DR STE 2180
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7057
Mailing Address - Country:US
Mailing Address - Phone:916-548-6018
Mailing Address - Fax:
Practice Address - Street 1:6060 SUNRISE VISTA DR STE 2180
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7057
Practice Address - Country:US
Practice Address - Phone:916-548-6018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 174400000X, 226300000X, 174H00000X
CA133N00000X
CA15067172M00000X, 173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Single Specialty