Provider Demographics
NPI:1710021787
Name:ANDERSON, MONIQUE MARIE GOMEZ (BS)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:MARIE GOMEZ
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11315 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3007
Mailing Address - Country:US
Mailing Address - Phone:310-537-5883
Mailing Address - Fax:310-537-5587
Practice Address - Street 1:11315 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3007
Practice Address - Country:US
Practice Address - Phone:310-537-5883
Practice Address - Fax:310-537-5587
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)