Provider Demographics
NPI:1710403985
Name:MONIZ, JESSICA NICOLE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:MONIZ
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 1:1045 E MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2618
Mailing Address - Country:US
Mailing Address - Phone:510-332-0988
Mailing Address - Fax:
Practice Address - Street 1:2702 CLAYTON RD.
Practice Address - Street 2:100
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-9451
Practice Address - Country:US
Practice Address - Phone:925-222-3775
Practice Address - Fax:818-562-0914
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF83693106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist