Provider Demographics
NPI:1578152286
Name:ROSAS-BAINES, MONICA (PHD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:ROSAS-BAINES
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 1:7514 W 88TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3415
Mailing Address - Country:US
Mailing Address - Phone:310-733-7480
Mailing Address - Fax:
Practice Address - Street 1:7514 W 88TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3415
Practice Address - Country:US
Practice Address - Phone:310-733-7480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18172103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical