Provider Demographics
NPI:1033701362
Name:GORDON, SIERRA MONIQUE
Entity Type:Individual
Prefix:MRS
First Name:SIERRA
Middle Name:MONIQUE
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SIERRA
Other - Middle Name:MONIQUE
Other - Last Name:RIPTOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 S BROADWAY STE 310
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5218
Mailing Address - Country:US
Mailing Address - Phone:925-264-1902
Mailing Address - Fax:
Practice Address - Street 1:800 S BROADWAY STE 310
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5218
Practice Address - Country:US
Practice Address - Phone:925-264-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty