Healthcare Provider Details

I. General information

NPI: 1124700786
Provider Name (Legal Business Name): KYLEE MONIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 CAMINO MIRA COSTA STE T
SAN CLEMENTE CA
92672-3508
US

IV. Provider business mailing address

3551 CAMINO MIRA COSTA STE T
SAN CLEMENTE CA
92672-3508
US

V. Phone/Fax

Practice location:
  • Phone: 949-272-4444
  • Fax:
Mailing address:
  • Phone: 949-272-4444
  • Fax: 949-272-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: