1134257512 NPI number — MRS. MONICA ARIANA JAQUEZ LMFT

Table of content: MRS. MONICA ARIANA JAQUEZ LMFT (NPI 1134257512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134257512 NPI number — MRS. MONICA ARIANA JAQUEZ LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAQUEZ
Provider First Name:
MONICA
Provider Middle Name:
ARIANA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODRIGUEZ
Provider Other First Name:
MONICA
Provider Other Middle Name:
ARIANA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134257512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 451653
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90045-8519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-564-6490
Provider Business Mailing Address Fax Number:
310-510-6438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3868 W CARSON ST STE 308
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90503-6711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-564-6490
Provider Business Practice Location Address Fax Number:
310-510-6438
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  86485 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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