Provider Demographics
NPI:1689244568
Name:FRAILE, MONIQUE ALESSANDRA
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ALESSANDRA
Last Name:FRAILE
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 1:10500 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6944
Mailing Address - Country:US
Mailing Address - Phone:323-702-0650
Mailing Address - Fax:
Practice Address - Street 1:10500 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6944
Practice Address - Country:US
Practice Address - Phone:323-702-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician