Healthcare Provider Details

I. General information

NPI: 1669900262
Provider Name (Legal Business Name): LETICIA MONRROY MFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LETICIA MONRROY

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 E INTERNATIONAL AIRPORT RD STE 100
ANCHORAGE AK
99518-1409
US

IV. Provider business mailing address

920 E BROADWAY
GLENDALE CA
91205-1204
US

V. Phone/Fax

Practice location:
  • Phone: 907-570-6382
  • Fax:
Mailing address:
  • Phone: 818-242-8403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number183167
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: