Provider Demographics
NPI:1417737735
Name:TAITE, NONA MONIQUE
Entity Type:Individual
Prefix:
First Name:NONA
Middle Name:MONIQUE
Last Name:TAITE
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 1:200 W COMPTON BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3174
Mailing Address - Country:US
Mailing Address - Phone:310-433-0839
Mailing Address - Fax:
Practice Address - Street 1:200 W COMPTON BLVD STE 800
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3174
Practice Address - Country:US
Practice Address - Phone:310-433-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1180171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical