MEDICARE: MS. MONIQUA ELENA CHRISTENSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	13551	CA
2	101YP2500X	Professional Counselor
3	101YM0800X	Mental Health Counselor	138363	CA

General Provider Information

NPI Number	:	1205609328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MONIQUA ELENA CHRISTENSEN

Provider Business Mailing Address
First Line	:	PO BOX 9093
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92658-1093
Country	:	US
Telephone Number	:	310-408-8546
Fax Number	:

Provider Business Practice Location Address
First Line	:	4425 JAMBOREE RD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-3024
Country	:	US
Telephone Number	:	310-408-8546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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