Healthcare Provider Details

I. General information

NPI: 1942827688
Provider Name (Legal Business Name): DARCIE MONINGKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 HAMPSHIRE RD STE P
WESTLAKE VILLAGE CA
91361-6020
US

IV. Provider business mailing address

319 OHIO ST APT 14
PASADENA CA
91106-4240
US

V. Phone/Fax

Practice location:
  • Phone: 805-852-5055
  • Fax:
Mailing address:
  • Phone: 951-208-9693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: