Basic Information
| Provider Information | |||||||||
| NPI: | 1962524124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | AS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6978 SAGEBRUSH WAY | ||||||||
| Address2: | |||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923361730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512376220 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10421 S FIGUEROA ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900034423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008547771 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.