MEDICARE: DR. NICKI MONTI PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MP22752	CA

General Provider Information

NPI Number	:	1922233345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICKI MONTI PHD

Provider Business Mailing Address
First Line	:	PO BOX 46337
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-0337
Country	:	US
Telephone Number	:	818-558-6379
Fax Number	:	818-558-6394

Provider Business Practice Location Address
First Line	:	1140 N FAIRFAX AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5307
Country	:	US
Telephone Number	:	818-558-6379
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	05/29/2009

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