Provider Demographics
NPI:1356671895
Name:VAZIRE, MONIQUE (MFT)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:VAZIRE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3477 KENNETH DR
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4219
Mailing Address - Country:US
Mailing Address - Phone:650-248-1678
Mailing Address - Fax:650-964-6994
Practice Address - Street 1:1059 EL MONTE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4601
Practice Address - Country:US
Practice Address - Phone:650-248-1678
Practice Address - Fax:650-964-6994
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42868106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist