Healthcare Provider Details

I. General information

NPI: 1710521646
Provider Name (Legal Business Name): MONIQUE RENEE SINCLARE RN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 WILSHIRE BLVD STE 1410
LOS ANGELES CA
90048-5815
US

IV. Provider business mailing address

6200 WILSHIRE BLVD STE 1410
LOS ANGELES CA
90048-5815
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95016309
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95023613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: