Healthcare Provider Details

I. General information

NPI: 1558906925
Provider Name (Legal Business Name): MONARCH KIDS THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2019
Last Update Date: 11/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 PASEO DEL NORTE STE D1
CARLSBAD CA
92011-1118
US

IV. Provider business mailing address

11835 CARMEL MOUNTAIN RD STE 1304-337
SAN DIEGO CA
92128-4609
US

V. Phone/Fax

Practice location:
  • Phone: 856-816-6951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: GINA YOO
Title or Position: CEO
Credential: MS OTR/L
Phone: 856-816-6951