Healthcare Provider Details

I. General information

NPI: 1376400101
Provider Name (Legal Business Name): MONIQUE CARLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 ARLINGTON AVE STE 100
LOS ANGELES CA
90018-1300
US

IV. Provider business mailing address

619 S WESTLAKE AVE
LOS ANGELES CA
90057-4364
US

V. Phone/Fax

Practice location:
  • Phone: 323-334-9000
  • Fax:
Mailing address:
  • Phone: 323-334-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: