Healthcare Provider Details

I. General information

NPI: 1427474626
Provider Name (Legal Business Name): MONICA STIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10182 INDIANAN AVE
RIVERSIDE CA
92503
US

IV. Provider business mailing address

6299 BLYTHE AVE
HIGHLAND CA
92346-2027
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-2400
  • Fax:
Mailing address:
  • Phone: 805-598-0646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: