Provider Demographics
NPI:1497985832
Name:GRACE, MONIKA-MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONIKA-MARIA
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 BALTIMORE DR UNIT 161
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1652
Mailing Address - Country:US
Mailing Address - Phone:619-381-8472
Mailing Address - Fax:619-839-7983
Practice Address - Street 1:135 E 3RD AVE STE B
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4252
Practice Address - Country:US
Practice Address - Phone:619-381-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW416Medicare PIN