Provider Demographics
NPI:1619856697
Name:KINNEBERG, MONICA (CMT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:KINNEBERG
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25841 AVATAR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4508
Mailing Address - Country:US
Mailing Address - Phone:213-431-3080
Mailing Address - Fax:
Practice Address - Street 1:27901 LA PAZ RD STE E
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3932
Practice Address - Country:US
Practice Address - Phone:949-643-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97420225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist