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General NPI Number Information
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NPI Number | 1902590748
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Entity Type | Individual
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Provider Name | AHSABI-MONIQUE L BURRIS
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Gender | Female
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 09/30/2023
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Provider Practice Location Address
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Address Line | 13925 SAN PABLO AVE STE 203
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City | SAN PABLO
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State | CA
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Zip | 94806-3676
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Country | US
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Telephone | 510-435-4783
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Fax |
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Provider Business Mailing Address
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Address Line | 1844 62ND ST
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City | BERKELEY
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State | CA
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Zip | 94703-2703
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Country | US
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Telephone | 510-435-4783
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT141609
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License Number State | CA
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