Provider Demographics
NPI:1932408754
Name:KINGKADE, MARLA MONICA
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:MONICA
Last Name:KINGKADE
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 1:1094 CUDAHY PL
Mailing Address - Street 2:SUITE 314
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3931
Mailing Address - Country:US
Mailing Address - Phone:619-276-8112
Mailing Address - Fax:619-276-8230
Practice Address - Street 1:1094 CUDAHY PL
Practice Address - Street 2:SUITE 314
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3931
Practice Address - Country:US
Practice Address - Phone:619-276-8112
Practice Address - Fax:619-276-8230
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator