Provider Demographics
NPI:1275034522
Name:LONGORIA, MONICA EVA
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:EVA
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 PIVA CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-6200
Mailing Address - Country:US
Mailing Address - Phone:408-648-7323
Mailing Address - Fax:
Practice Address - Street 1:671 PIVA CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-6200
Practice Address - Country:US
Practice Address - Phone:408-648-7323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst