Provider Demographics
NPI:1356837173
Name:BASQUEZ, MONICA VALESKA (LMFT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:VALESKA
Last Name:BASQUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4783 THORNBUSH WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0756
Mailing Address - Country:US
Mailing Address - Phone:951-446-8669
Mailing Address - Fax:
Practice Address - Street 1:4783 THORNBUSH WAY
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0756
Practice Address - Country:US
Practice Address - Phone:951-446-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-04
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105032106H00000X
CA128892106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist