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General NPI Number Information
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NPI Number | 1003799701
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Entity Type | Individual
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Provider Name | MICHELLE RODRIGUEZ MONGE
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Gender | Female
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 1501 IMPERIAL AVE
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City | SAN DIEGO
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State | CA
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Zip | 92101-7638
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Country | US
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Telephone | 619-645-6405
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Fax |
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Provider Business Mailing Address
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Address Line | 550 W DATE ST APT 606
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City | SAN DIEGO
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State | CA
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Zip | 92101-2762
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Country | US
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Telephone | 619-900-4622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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