Provider Demographics
NPI:1225141989
Name:MONROE FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:MONROE FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:BECERRIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-772-8237
Mailing Address - Street 1:19030 LENTON PL SE
Mailing Address - Street 2:#274
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1353
Mailing Address - Country:US
Mailing Address - Phone:425-772-8237
Mailing Address - Fax:
Practice Address - Street 1:375 BUTLER STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272
Practice Address - Country:US
Practice Address - Phone:425-772-8237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA 00021300261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1902806771OtherMY INDIVIDUAL NPI NUMBER
WA1075258Medicaid
WAA52225Medicare UPIN