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General NPI Number Information
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NPI Number | 1497985832
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Entity Type | Individual
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Provider Name | MONIKA-MARIA GRACE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 135 E 3RD AVE STE B
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City | ESCONDIDO
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State | CA
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Zip | 92025-4252
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Country | US
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Telephone | 619-381-8472
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 BALTIMORE DR UNIT 161
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City | LA MESA
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State | CA
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Zip | 91942-1652
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Country | US
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Telephone | 619-381-8472
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Fax | 619-839-7983
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY24462
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License Number State | CA
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