Healthcare Provider Details

I. General information

NPI: 1346956810
Provider Name (Legal Business Name): MRS. SERENITY MAE MONROE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CONCORD AVE STE 185
CONCORD CA
94520-5006
US

IV. Provider business mailing address

1200 CONCORD AVE STE 185
CONCORD CA
94520-5006
US

V. Phone/Fax

Practice location:
  • Phone: 844-952-5590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-254882
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: