Provider Demographics
NPI:1871209692
Name:AXUME, MONICA ISABEL
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ISABEL
Last Name:AXUME
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 1:8144 ESCONDIDO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-1534
Mailing Address - Country:US
Mailing Address - Phone:661-678-3894
Mailing Address - Fax:
Practice Address - Street 1:8144 ESCONDIDO CANYON RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510-1534
Practice Address - Country:US
Practice Address - Phone:661-678-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00000000OtherMEDICAL