Individual
MONQUENETTE VESHA WALTERS SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
216 W HARDING WAY, STOCKTON, CA 95204-5607
(209) 456-4697
Mailing address
216 W HARDING WAY, STOCKTON, CA 95204-5607
(209) 456-4697
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
KK261564
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30-0730025
—
CA
Enumeration date
08/08/2018
Last updated
08/08/2018
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