Basic Information
| Provider Information | |||||||||
| NPI: | 1316433246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DATTA | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4421 GILBERT ST APT 116 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946114610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503805665 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3505 BROADWAY FL 10 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946115714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107522834 | ||||||||
| FaxNumber: | 5107526754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2018 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | GC001000 | CA | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.