Provider Demographics
NPI:1134257512
Name:JAQUEZ, MONICA ARIANA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:ARIANA
Last Name:JAQUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:ARIANA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 451653
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-8519
Mailing Address - Country:US
Mailing Address - Phone:310-564-6490
Mailing Address - Fax:310-510-6438
Practice Address - Street 1:3868 W CARSON ST STE 308
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6711
Practice Address - Country:US
Practice Address - Phone:310-564-6490
Practice Address - Fax:310-510-6438
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86485106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist