Healthcare Provider Details

I. General information

NPI: 1588237432
Provider Name (Legal Business Name): MONIQUE AMY PRITCHARD CADC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MO PRITCHARD CADC-I

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 TULLY RD STE 304
SAN JOSE CA
95122-3055
US

IV. Provider business mailing address

1340 TULLY RD STE 304
SAN JOSE CA
95122-3055
US

V. Phone/Fax

Practice location:
  • Phone: 408-271-3900
  • Fax:
Mailing address:
  • Phone: 408-271-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI39220623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: