Healthcare Provider Details

I. General information

NPI: 1356671895
Provider Name (Legal Business Name): MONIQUE VAZIRE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 EL MONTE AVE SUITE B
MOUNTAIN VIEW CA
94040-4601
US

IV. Provider business mailing address

3477 KENNETH DR
PALO ALTO CA
94303-4219
US

V. Phone/Fax

Practice location:
  • Phone: 650-248-1678
  • Fax: 650-964-6994
Mailing address:
  • Phone: 650-248-1678
  • Fax: 650-964-6994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number42868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: