Provider Demographics
NPI:1316811268
Name:MONARDEZ, CORBIN
Entity type:Individual
Prefix:
First Name:CORBIN
Middle Name:
Last Name:MONARDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9717 CRAIGLEE ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1413
Mailing Address - Country:US
Mailing Address - Phone:626-230-0779
Mailing Address - Fax:
Practice Address - Street 1:2065 W COLLEGE AVE APT 2122
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-7025
Practice Address - Country:US
Practice Address - Phone:626-230-0779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156920106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist