Provider Demographics
NPI:1487931200
Name:ORTEGA GONZALEZ, MONIKA LISETTE (MA)
Entity type:Individual
Prefix:MRS
First Name:MONIKA
Middle Name:LISETTE
Last Name:ORTEGA GONZALEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:MONIKA
Other - Middle Name:LISETTE
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 W CAMERON AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2726
Mailing Address - Country:US
Mailing Address - Phone:323-652-1878
Mailing Address - Fax:
Practice Address - Street 1:1515 W CAMERON AVE STE 350
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2726
Practice Address - Country:US
Practice Address - Phone:323-652-1878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT121373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist