Healthcare Provider Details

I. General information

NPI: 1457910259
Provider Name (Legal Business Name): TAYLOR NICOLE MONGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date: 03/05/2024
Reactivation Date: 03/25/2024

III. Provider practice location address

1245 E SANTA CLARA ST
SAN JOSE CA
95116-2337
US

IV. Provider business mailing address

1245 E SANTA CLARA ST
SAN JOSE CA
95116-2337
US

V. Phone/Fax

Practice location:
  • Phone: 408-240-0070
  • Fax:
Mailing address:
  • Phone: 408-240-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: