Healthcare Provider Details

I. General information

NPI: 1710174552
Provider Name (Legal Business Name): MONICA JEANNE PAPPAPETRU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONICA JEANNE LORENZ

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 MAGNOLIA AVE
RIVERSIDE CA
92503
US

IV. Provider business mailing address

PO BOX 640
LAKE ELISNORE CA
92531-5724
US

V. Phone/Fax

Practice location:
  • Phone: 951-345-9321
  • Fax:
Mailing address:
  • Phone: 951-345-9321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number43362
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number43362
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number43362
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number43362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: