Provider Demographics
NPI:1497887095
Name:MONROE, AMBER M
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:M
Last Name:MONROE
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 1:4565 RUFFNER ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2262
Mailing Address - Country:US
Mailing Address - Phone:619-972-9386
Mailing Address - Fax:
Practice Address - Street 1:4565 RUFFNER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2262
Practice Address - Country:US
Practice Address - Phone:619-972-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8634OtherINSYST NUMBER