Provider Demographics
NPI:1508049586
Name:PANIAGUA, MONICA RAE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RAE
Last Name:PANIAGUA
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 1:1609 E 18TH ST APT 25
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-5056
Mailing Address - Country:US
Mailing Address - Phone:619-434-9595
Mailing Address - Fax:
Practice Address - Street 1:1609 E 18TH ST APT 25
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-5056
Practice Address - Country:US
Practice Address - Phone:619-434-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)