Provider Demographics
NPI:1992502181
Name:SUBER, MONIFA SAMORA
Entity type:Individual
Prefix:
First Name:MONIFA
Middle Name:SAMORA
Last Name:SUBER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W ALAMEDA AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4191
Mailing Address - Country:US
Mailing Address - Phone:323-547-2662
Mailing Address - Fax:
Practice Address - Street 1:4100 W ALAMEDA AVE FL 3
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4191
Practice Address - Country:US
Practice Address - Phone:323-547-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA153019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist