Provider Demographics
NPI:1982208377
Name:BAHENA, MONICA ESTHER
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ESTHER
Last Name:BAHENA
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 1:2130 W CRESCENT AVE APT 1061
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3812
Mailing Address - Country:US
Mailing Address - Phone:714-398-6418
Mailing Address - Fax:
Practice Address - Street 1:2130 W CRESCENT AVE APT 1061
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3812
Practice Address - Country:US
Practice Address - Phone:714-398-6418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41744167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician